Laserfiche WebLink
9255517888 Une 1 <br />im GfiflfR-RYAN INC. <br />09:56:18 01-02-2014 5/10 <br />Job # 20-592715 <br />VED <br />Spill Bucket Testing Report Form M!CM <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 regula e i a . 2 01 <br />0 <br />_ t Y i1 1� • ►t = t <br />Facility Name: Arco 5450 Date of Testing: 12/23/2013 <br />acility Address: 1617 W Fremont St. Stockton HEALTH <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing: 11/26/2013 <br />Name ot LocalAgency inspector (Ypresent during testing) : Stacy Rivera <br />l� i ► Y i C 1► � ll � t ►1 <br />Company Name: Gettler-Ryan Inc., 6747 Sierra Court Suite J, Dublin, Ca. 94568 Ph.# 925-551-7555 <br />Technician Conducting Test: Elodio Sanchez <br />Credentials: (1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other (Specify) <br />License Number. 220793 ICC Tech Number: 8126818 -UT <br />'i. SPTT,T. RITC_KF.T TFSTING TNlPC11RMA"M <br />Test Method Used: <br />Hd�tatic <br />Vacuum <br />Other <br />Test Equipment Used: <br />Standard Tape Measurer <br />Equipment Resolution: <br />1/16" <br />VM <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />1 87-1 <br />2 87-2 <br />3 91 4 <br />Bucket Installation Type: <br />Direct Bury <br />X Contained in Sum <br />Direct Bury <br />Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Bucket Diameter: <br />12" <br />I214 <br />12" <br />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test: <br />13" <br />10min <br />13" <br />10min <br />13#1 <br />10min <br />Test Start Time (Ti): <br />2:30 <br />2:30 <br />2:30 <br />Initial Reading (Ri): <br />14" <br />14" <br />14" <br />Test End Time (Tf): <br />3:30 <br />3:30 <br />3:30 <br />Final Reading (Rf) <br />14" <br />14" <br />14" <br />Test duration (Tf - Ti): <br />1hr <br />Ihr <br />lhr <br />Change in Reading (Rf-Ri): <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or Criteria: <br />0 <br />0 <br />0 <br />0 <br />Test Results: - <br />X ;Pass Fail . <br />Pass Fall <br />Pass Fair <br />Pass.' Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />5 gal OPW rill Buckets <br />CERTFICATION 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: Date: 12/23/2013 <br />(1) 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 />