Laserfiche WebLink
SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name:YRC#813 1 Date of Testing: 2/26/2025 <br /> Facility Address: 1535 East Pescadero Avenue,Tracy,Ca,95304 <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(f present during testing):C.Presto <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:Nwestco LLC <br /> Technician Conducting Test:Michael Stromecki <br /> Credentials': 0 CSLB Contractor ❑� ICC Service Tech. 0 SWRCB Tank Tester Other(Spec) <br /> License Number(s): 1073967 8339168 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑✓Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Ruler Equipment Resolution:1/16" <br /> Identify Spill Bucket(By Tank 1 P--W <br /> 3 4Number, Stored Product, etc.) Waste Oil Near Rackaste Oil Near Gate Anti Freeze Gear Oil <br /> Bucket Installation Type: 0 Direct Bury ❑Direct Bury 0 Direct Bury ®Direct Bury <br /> ❑Contained in Sump 0 Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 13 12 13 13 <br /> Bucket Depth: 191/2 16 20 3/4 21 <br /> Wait time between applying <br /> vacuum/water and start of test: 5 Min 5 Min 5 Min 5 Min <br /> Test Start Time(TI): 9:57 AM 10:10 AM 9:17 AM 9:18 AM <br /> Initial Reading(RI): 20 3/16" 14 15/16" 18 9/16" 19 1/81, <br /> Test End Time(TF): 10:57 AM 11:10 AM 10:17 AM 10:18 AM <br /> Final Reading(RF): 20 3/16" 14 15/16" 18 9/16" 19 1/8" <br /> Test Duration(TF—TI): 60 Min 60 Min 60 Min 60 Min <br /> Change in Reading(RF-RI): 0" 0" 0" 0" <br /> Pass/Fail Threshold or <br /> 1/8" 1/8" -1/8 <br /> Criteria: "Test Result: 0 Pass ❑Fail 0 Pass ❑Fail 0 Pass ❑Fail 0 Pass ❑Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> No repairs required. <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 Signature: Date: 2/26/2025 <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 />