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0 SWRCB,January 2006 <br /> 9. Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO #05450, CC 18022647 1 DateofTesting: 08/05/2008 <br /> Facility Address: 1617 W. FREMONT , STOCKTON, CA, 95205 <br /> Facility Contact: DEALER/MANAGER Phone: (209) 462-1617 <br /> Date Local Agency Was Notified of Testing: 07/16/2008 <br /> Name of Local Agency Inspector(if present during testing): RAY VON FLUE <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: DENNIS RUE <br /> Credentials I:❑CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester E Other(Specify) ICC <br /> License Number: 5246067-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X❑ Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used:TAPE MEASURE Equipment Resolution:VISUAL <br /> Identify Spill Bucket(By Tank 1 1 PRE FILL Z 2 REG FILL 3 3 REG FILL 4 <br /> Number,Stored Product, etc.) <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury E]Direct Bury <br /> ®Contained in Sump ®Contained in Sump ®Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12 12 12 <br /> Bucket Depth: 14 14 13 <br /> Wait time between applying 5 5 5 <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 0900 0900 0900 <br /> Initial Reading(RI ): 13.50 13 12 <br /> Test End Time(TF): 1000 1000 1000 <br /> Final Reading(RF ): 13.50 13 12 <br /> Test Duration: 60 MINS. 60 MINS. 60 MINS. <br /> Change in Reading(R F-RI ): 0 0 0 <br /> Pass/Fail Threshold or P P P <br /> Criteria: <br /> 71 Test Results Pass Fait ' Pass Fail P Fail Pass Fail <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: asp- Date: 08/05/2008 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />