Laserfiche WebLink
NoV 19 %ACB, January 2006 <br />Spill Bucket Testing Report Form HF 'TV4 <br />AL <br />This form is intended for use by contractors performing annual testing of UST Spill cont i ,letedform and <br />printouts from tests (if applicable), should be provided to the facility ownerloperator Xo Itory agency. <br />1. FArT1.ITVTNVn1DX4ATTn?hT <br />Facility Name: Arco Date of Testing: 10/19/2016 <br />Facility Address: 2430 Joe Pombo Pkwy, Tracy, Ca. 95376 <br />Facility Contact: Ranjeet I Phone: (209) 579-4014 <br />Date Local Agency Was Notified of Testing: 10/2/2016 <br />Name of Local Agency Inspector (ii(present during testing): Stacy Rivera <br />2. TESTING CONTRACTOR INFORMATION <br />Company' ame: Diamond Petroleum Services, Inc. <br />Technician Conducting Test: Guadalut)e Sanchez <br />Credentials': x CSLB Contractor x WC Service Tech. 0 SWRCB Tank Tester 0- Other <br />License Number(s): 1005444 5250451 -UT <br />3- %PiT,i.RiirwrTTr4zTimf--YMUi-17DXXA'IrYt-IXT <br />— ( triumuu injurmarion on repairs macre prior to testing, and recommended follow-upfar failed tests) <br />87 Sinhon spill bucket -needs to be replaced <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 Signatures- -3 <br />Date 10/19/2016 <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 />