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h <br /> GETTIFR - RYAN INC. <br /> 1820 - 2542 <br /> . <br /> SEP 1018 SWRCB . January2006 <br /> Spill Bucket Testing Report Form �� <br /> This form is intended Jur use by contractors performing annual tenting of ?ST .vowili�riwtx� 'c7,h}c`�resTbc� Completed grin (aul <br /> p iintouts firuu tests (if applicable), shouhl be provided to the firkin ownerr'otfilAi�T/ji F IM®r TAF1N'Tlocal rrgulatoo. agency. <br /> I . FACILITY iNFORMATION <br /> Facility Name: Arco 2093 Date of Testing : 8 / 30 / 2018 <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 /> Name ot' Local Agency Inspector (if present during testing) <br /> 1. TESTING CONTRACTOR INFORMATION <br /> Company Name: G00rr- 16 ;, n Inc . GtiU _> tiicrra f uw i , tinily t : . Uul ,lin . ( ' ;r. 9.1 :N6 { I ' 11 . " 93 > - . � I - 75 <br /> Technician Conducting Test : ffavid Rouse <br /> Credentials: ( 1 ) i tit t; t aniractf+ r ICC service Tech . SWRCB Tank Tester Other (Speci(i9 <br /> License Number. 3 ICC Tech Number: <br /> 3 . SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hsdrouaric Vacuum Other <br /> Test Equipment Used : tiLuutard 1 ape Nlt.innt , r Equipment Resolution : i I (, " <br /> Identify Spilt Bucket (Nr Tank 1 2 3 3 <br /> Manher, Stored Product. etc ) 8 7 - Vapor 87 - Vapor 87 - Vapor 91 - Vapor <br /> ircct Bury irect Bury ireci Bury irect Bury <br /> Bucket Installation Type: <br /> X ontamed in Sump QX Contained in Sump Xaontained in Sump ,XTontamcd ,, Swap <br /> Bucket Diameter: 14 14 14 14 <br /> Bucket Depth : 11 11 11 11 <br /> Wait time between appl} ing <br /> sacuum/water and start of test 5 mins 5 mins 5 mins 5 mins <br /> Test Start Time (Ti): 10 : 0 0 10 : 00 10 : 00 100 00 <br /> Initial Reading ( Ri) : 9 1 / 2 9 1 / 2 9 1 / 2 9 1 / 2 <br /> Test End Time (Tf) : 11 : 0 0 11 : 0 0 11 : 00 11 : 0 0 <br /> Final Reading ( Rf) 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 /> Pass+ Fail Threshold or Criteria. <br /> Test Results:ju Pass QFail i Pass OFail Pass 017nil ] Pass ❑Fail <br /> Continents - (include in olination oil repairs male 1114or to testis our) recunimended ollo ,r-u , or oiled test.0 <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that alp the information contained in this art is (rue, aceurate, and in fall compliance with legal reyuirenuvta <br /> Technician's Signature: Date 8/30/2018 <br /> ( 1 ) State lases and regulations do not currently require testing to be performed b} a qualified contractor. lim% eser, loeal requirements <br /> may be more stringent . <br />