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SWRCB,January 2006 <br /> Spill Bucket Testing Report For <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(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Arco I Date of Testing: 10/16/2012 <br /> Facility Address: 2430 Joe Pombo Pkwy,Tracy,Ca.95376 <br /> Facility Contact: Ranjeet Phone: (209)5794014 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(afpresent during testing): Thuy Tran <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services, Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 Tl: 87 Master Fill 2 T2:87 Master Fill 3 T3: 87 Syphon 4 T4: 91 Fill <br /> Number, Stored Product, etc. West East Fill <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> x Contained in Sump x Contained in Sump x Contained in Sump Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 17" 17''/4" 161/4" 163/4" <br /> Wait time between applying 1 minute 1 minute 1 minute 1 minute <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 1:10 P.M. 1:10 P.M. 1:11 P.M. 1:12 p.m. <br /> Initial Reading(RI): 15" 15 3/4" 14 3/8" 151/4'9 <br /> Test End Time(TF): 2:10 p.m. 2:10 p.m. 2:11 p.m. 2:12 p.m. <br /> Final Reading(RF): 15" 15 3/4" 14 3/8" 151/4" <br /> Test Duration(TF—TI): I hr lhr I hr 1 hr <br /> Change in Reading(RF-Rj): 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> TestResult: x Pass ❑Fail x Pass ❑Fail x Pass ❑Fail x 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 Signatud Date 10/16/2012 <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 />