Laserfiche WebLink
.,,. ,%ECEIVED <br /> January 2006 <br /> Spill Bucket Testing Report Forme ay ABENVIRONMENTAL HEALTH <br /> This form is intended for use by contractors performing annual testing of UST spill containment fd and <br /> rintouts om tests i a hcable should be provided to thefacility owner/o erator br s" focale lator agency. <br /> p (f PP ) P f tJ P f `., gu Y <br /> ,.ITIS <br /> 1. FACILITY INFORMATION <br /> Facility Name: TWO GUYS VALERO Date of Testing: 06-14-18 <br /> Facility Address: 147 E LATHROP RD LATHROP CA 95330 <br /> Facility Contact: GREG Phone: 209-858-2666 <br /> Date Local Agency Was Notified of Testing:04-25-18 <br /> Name of Local Agency Inspector(if present during testing): SAN JOAQUIN CO. <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑ Zane A.Nimmo ❑ David A.Winkler ® Felix G.Ramirez ❑ Edward Stearns <br /> #8883064-UT #8883059-UT #8883072-UT #8883080-UT <br /> Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑ Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 87 2 91 3 DIE 4 <br /> Number, Stored Product, etc. <br /> ®Direct Bury ®Direct Bury <br /> ®Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ElContained in E]Contained in <br /> ❑Contained in Sump El Contained in Sump Sump Sum <br /> Bucket Diameter: 11 11 11 <br /> Bucket Depth: 13 13 13 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 900 900 900 <br /> Initial Reading(RI): 12 12 12 <br /> Test End Time(TF): 1000 1000 1000 <br /> Final Reading(RF): 10 12 12 <br /> Test Duration(TF—Ti): 1 HOUR 1 HOUR 1 HOUR <br /> Change in Reading(RF-Ri): 2 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result: ❑ Pass Z Fail ® Pass ❑Fail i ® Pass ❑Fail ❑ Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW BUCKETS <br /> ALL BUCKETS HOLD 5 GALLONS <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: f Date:06-14-18 <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 />