COMPLIANCE INFO_2007-2015 - Laserfiche WebLink

Home Browse Search

SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Shell I-5 Date of Testing 03/28/2012 Facility Address: 717 W. Eighth St., Stockton, Ca. 95206 Facility Contact: Joe Dangtran Phone: (209) 939-0961 Date Local Agency Was Notified of Testing : Name of Local Agency Inspector (rf present during testing): Thuy Tran 2. TESTING CONTRACTOR INFORMATION Company Name: Reliable Petroleum Services, Inc. Technician Conducting Test: Guadalupe Sanchez Credentials': x CSLB Contractor x ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) License Number(s): 883706 5250451 -UT Z CPTi 7 RTTI' L? T rr1V rrYWTn SATiNd-u"sm Test Method Used: xHydrostatic O Vacuum 0 Other s Test Equipment Used Standard Tape Measure Identify Spill Bucket (By Tank 1 Tl: 87 Fill Number, Stored Product, etc. Bucket Installation Type: Direct Bury x Contained in Sump Bucket Diameter: 12" r 2 T2: 91 Fill Direct Bury x Contained in Sump 12" Equipment Resolution: N/A 3 T3. Diesel Fill 4 T4: Direct Bury Direct Bury x Contained in Sump Contained in Sum 12" Bucket Depth: 14" 14 1/8" 143/4" Wait time between applying vacuum/water and start of test: I minute 1 minute 1 minute Test Start Time (TI): 2:52 p.m. 2:51 p.m. 2:53 p.m. Initial Reading (Ro: 13 1/8" 13 ''/," 13 7/8" Test End Time (TF): 3:52 p.m. 3:51 p.m. 2:53 p.m. Final Reading (RF): 13 1/8" 13 '/" 13 7/8" Test Duration (TF— TI): 1 hr lhr 1 hr Change in Reading (RF- RI): 0 0 0 Pass/Fail Threshold or Criteria: 1/16" 1/16" 1/16" Test Result: x Pass ❑ Fail irAMM1Pn*Q -1-4- z Pass ❑ Fail z Pass ❑ Fail Pass ❑ Fail i---------- -•y�-• •••»•.�.• •.•.. c w rlur 6u texttn ana recommenaett oUow-u orfailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Sign Date 03/28/2012 ' �4 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.