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SWRCB,January 2006 <br /> 9. SIDI Bucket Testing Reporoorm <br /> This form is intended for use by contractors performing annual testing of LIST 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: FLYING J 0500075 Date of Testing: 08/01/2008 <br /> Facility Address: 1501 N. JACK TONE RD RIPON, CA, 95366 <br /> Facility Contact: JOSE Phone: (2 0 9) 599-4141 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: JARROD COOKE <br /> Credentials I: CSLB Contractor ❑ICC Service Tech. ❑SWRCB Tank Tester a Other(Spec) a <br /> License Number: 743160 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic ❑ Vacuum El Other <br /> Test Equipment Used:vp1t Equipment Resolution:vplt to gph <br /> Identify Spill Bucket(By Tank 1 1 DIE FILL 2 2 DIE FILL 3 3 DIE FILL 4 <br /> Number,Stored Product, etc) <br /> Bucket Installation Type: ❑X Direct Bury xQ Direct Bury xD Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 1811 1811 1811 <br /> Bucket Depth: 1611 1611 16" <br /> Wait time between applying 5min 5min 5min <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 12:05 12:12 12:08 <br /> Initial Reading(RI ): 5.372 9.784 5.114 <br /> Test End Time(TF ): 12:2 0 12:27 12:23 <br /> Final Reading(RF ): 5.286 9.943 5.114- <br /> Test <br /> .114Test Duration: 15min 15min 15min <br /> Change in Reading(R F-RI ): 01gph .01gph .000gph <br /> Pass/Fail Threshold or 05gph .05gph .05gph <br /> Criteria: <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: P�- Date: 08/01/2008 <br /> I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />