Laserfiche WebLink
6ETTLE114YAN INC. GR Job # 1820 - 2542 <br /> SWRCB , January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is i »ended for use ht' contractors performing antral testing of UST spill coruuinnient sawcui es The Completed furtn and <br /> p141111mits front lents (if applicable), should he provided to the ftciliti , ownerioperatrm for stibininul to the local regidalot}t agenc•.i . <br /> 1 . FACILITY INFORMATION <br /> Facility Name: Arco 2093 Date of Testing: 8 / 30 /02018 <br /> Facility Address: 3425 Tracy Blvd . Tracy 95376 <br /> Facility Contact: Daryl Lee Phone: 415 - 902 - 5089 <br /> Date Local Agency Was Notified of Testing: <br /> , ame olo LocalAgency Inspector (Y-present r urinjg resting) ; <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: t . ttili r- 11,81111 lilt . , 0,807 !linin ( uurt . `iiuitc t ) , Dublin , Cna 4.1564 I ' ll , !! 02 . 5 ; I " 5 �5 <br /> Technician Conducting Test: David Rouse <br /> Credentials: ( 1 ) t St R ( onlr;utill ICC service Tech. SWRCB Tank Tester Other (Specijr) <br /> License Number ICC Tech Number: 8292530 <br /> 3 . SPILL BUCKET TESTING INFORMATION <br /> Test Rlcthod Used : Vacuum Other <br /> Test Equipment Used: Ntandurd Equipment Resolution: t Et= " <br /> Identify Spill Bucket (Br Tank I Z 3 4 <br /> Number. slorecll'roduet. etc ) 87 - Product 87 - product 87 - Product 91 - Product <br /> Bucket Installation Type: Direct Bury LIDirect Bury LjDirect Bury 07rect Bury <br /> X Contained in SumpXRContained in Sump Ex Contained in Sump gX Contained to Sump <br /> Bucket Diameter: 14 14 14 14 <br /> Bucket Depth: 11 11 11 1. 1 <br /> Wait time between applying <br /> saeuuni)svaler and start of test: 5mins 5mins 5mins 5mins <br /> Test Start Time (Ti ): 10400 10 : 00 10 . 00 10 : 00 <br /> Initial Reading (Ri ) ; 9 1 / 2 9 1 / 2 9 1 / 2 9 1 2 <br /> Test End Time (Tfl : 11 : 00 11 : 0 0 11 : 00 11 : 0 0 <br /> Final Reading ( Rfl 9 1 / 2 9 1 / 2 9 1 / 2 9 1 2 <br /> Test duration (Tf - Ti ): 1 hr 1 hr 1 hr 1 hr <br /> Change in Reading ( Rf-Ri ); 0 0 0 0 <br /> PassrFail Tlireshold or Criteria: u 0 u tt <br /> Test Results: ✓ Puss LJFail ✓ Puss Fuil Puss Foil ✓ Puss Fai [ <br /> Comments - (include infornnuion on repaim inaile l» ior tv tes!n{,t�. curd rccvrunrenrlcc( [<r0u1i arp ,fr»:Jiriled rcrt ) <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> 1 hereby certify that all the information contained in his re is true, accurate, and in full compliance math legal reyuirensents <br /> Technician's Signature. Date 8 / 30 / 2018 <br /> ( 1 ) State lases and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br /> may be more stringent . <br />