Laserfiche WebLink
,January 6 <br /> Spill Bucket Testing Report Form FEB 19 2016 <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The comple6W480NMENTAL <br /> and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulat <br /> 1.FACILITY INFORMATION <br /> Facility Name:CHEVRON#208117 Date of Testing:2/10/2016 <br /> Facility Address:755 S.TRACY BLVD,TRACY,CA 95376 <br /> Facility Contact:MGR-MARIA Phone:209-830-0370 <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:Gilbert Garcia <br /> Credentials): W CSLB Contractor W ICC Service Tech. r— SWRCB Tank Tester r Other(Specify) <br /> License Number(s):743160 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: Hydrostatic W Vacuum Other <br /> Test Equipment Used:VACUUM TEST Equipment Resolution:0.1 gph <br /> Spill Box#Tank T 1 Spill Box#Tank T 2 <br /> Identify Spill Bucket(By Tank PREMUM-Fill 1-Direct- REGULAR-Fill 1-Direct- Spill Box# Spill Box# <br /> Number, Stored Product, etc.) Grade level in containment Grade level in containment <br /> sump sump <br /> r" Direct Bury r" Direct Bury f Direct Bury r Direct Bury <br /> Bucket Installation Type: C Contained in Sump ro Contained in Sump r Contained in Sump r Contained in Sump <br /> Bucket Diameter: 12.00 12.00 <br /> Bucket Depth: 12.50 12.50 <br /> Wait time between applying <br /> 1 min 1 min min min <br /> vacuum/water and start of test <br /> Test Start Time(TI): 09:08:00 09:04:00 <br /> Initial Reading(RI): 30.00 in.H2O 30.00 in.H2O <br /> Test End Time(TF): 09:09:00 09:05:00 <br /> Final Reading(RF): 30.00 in.H2O 30.00 in.H2O <br /> Test Duration(TF—TI): 1 min 1 min <br /> Change in Reading(RF—RI): 0.00 in.H2O 0.00 in.H2O <br /> Pass/Fail Threshold or Criteria: +/-4.00 +/-4.00 +/- <br /> Test Result c Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECIINICIAN 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: — Date: 2/10/2016 <br /> 1 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. <br /> WO:2326364 <br />