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LM <br />N, 0 V 13 2017 <br />SWRCB, January 2006 <br />Spill Bucket Testing Report FWftONMENTAL HEALTH <br />This form is intendedfor use ky contractors performing annual testing of USTspill containme@ CyRARTUChKImpletedforin and <br />printouts from tests (if applicable), should be provided to the facility ownerloperator.16r submittal to the local regulatory agency. <br />Facility Name: Arco Date of Testing: 10/19/2017 <br />Facility Address: 2430 Joe Pombo Pkwy, Tracy, Ca. 95376 <br />Facility Contact: Vikram Phone: (209) 5794014 <br />Date Local Agency Was Notified ofTesting : 10/5/2017 <br />Name of Local Agency Inspector (if present during testing): Betty Ho <br />1101-M 10 all) 16140 OEM <br />Company Name: Diamond Petroleum Services, Inc. <br />Technician Conducting Test: Guadalupe Sanchez <br />Credentials': x CSLB Contractor x ICC Service Tech. SWRCB Tank Tester Other (Sped) <br />License Number(s): 1005444 5250451 <br />OM12 I a na fill rq By my 00 mz��� <br />Test Method Used: xHydrostatic -7 Vacuum D-1 Other <br />Test Equipment Used: Standard Tape Measure <br />Equipment Resolution: 1/16", <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />I TI: 87 Master Fill <br />West <br />2 T2: 87 Master Fill <br />East <br />3 T3: 87 Syphon <br />Fill <br />4 T4: 91 Fill <br />Bucket Installation Type: <br />Direct Bury <br />x Contained in Sum <br />Direct Bury <br />Contained in Sump <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />Contained in Sumg <br />Bucket Diameter: <br />12" <br />_x <br />12" <br />12" <br />12" <br />Bucket Depth: <br />16 Y2" <br />17" <br />16" <br />16 -1/4 <br />Wait time between applying <br />vacuum/water and start of test: <br />I minute <br />I minute <br />I minute <br />I minute <br />Test Start Time (Ti): <br />12:45 p.m. <br />2:17 p.m. <br />12:44 p.m. <br />12:44 p.m. <br />Initial Reading (Ri): <br />14" <br />14 3/8" <br />13 7/8" <br />14 3/8"' <br />Test End Time (Tr): <br />1:45 p.m. <br />3:17 p.m. <br />1:44 p.m. <br />1:44 p.m. <br />Reading (RF): <br />14" <br />14 3/8" <br />13 7/8" <br />14 3118" <br />-Final <br />Test Duration (TF - Ti): <br />I hr <br />1 h <br />I hr <br />I hr <br />Change in Reading (RF- Rj): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />1/16"' <br />1/16" <br />1/16" <br />1/16" <br />Test Result: <br />x Pass 0 Fail <br />x Pass 0 Fail <br />x Pass Fail <br />x Pass 0 Fail <br />. Comments — (include Ln_formation on repairs made prior to testing, and reconinii-,nciccljbllovi,-iipfor failed tests) <br />-Drain valve was replaced in the 87 Master 1~ ill Eastx In�nector BetriT Ho on site <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all lite infortnation contained in this report is true, accurate, and in fill compliance with legal requirentents. <br />Technician's Signature:� Date: 10/19/2017 <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 />