Laserfiche WebLink
y RECEIVED <br /> . So,dauµ��2006 <br /> Spill Bucket Testing Report Form ��AA'' [[UUII <br /> This form is intended for use by contractors performing annual testing of UST spill containment structbrr��l <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the��c�l''rT�u'7NR41 ®rayr� <br /> 1. FACILITY INFORMATION <br /> Facility Name: VALLEY SERVICE STATION ARCO Date of Tcstin­: 02-17-15 <br /> Facility Address: 16 EAST HARDING WAY STOCKTON CALIFORNIA 95204 <br /> Facility Contact: Phone: 209-466-9516 <br /> Date Local Agency Was Notified of Testing:2-10-15 <br /> Name of Local Agency Inspector(rf present during testing): SAN JOAQUIN CO JEFF WONG <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA"PEST 416 2"d Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑Lyle D.Nimmo ❑ Zane A.Nimmo ❑ David A.Winkler ® Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1/16 <br /> Identify Spill Bucket I/1i' 1(ink 1 87 2 87 3 01 4 DIE <br /> Vunnber, S'lored Product, c'lc.) <br /> ❑Direct Bury Direct Bury <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury ®Contained in ®Contained in <br /> ®Contained in Sump ®Contained in Sump Sump Sum <br /> Bucket Diameter: 11 11 I 1 11 <br /> Bucket Depth: 14 14 1 1 12 1/2 <br /> Wait time between applying _ <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 1021 1021 1021 1021 <br /> Initial Reading(Rj): 13 13 10 11 1/2 <br /> Test End Time(TF): 1121 1121 1121 1031 <br /> Final Reading(RF): 13 13 10 10 <br /> Test Duration(TF—Tj): I HOUR I HOUR 1 HOUR 1 HOUR <br /> Change in Reading(RF-Rj): 0 0 0 0 <br /> Pass/Fail Threshold or _ <br /> Criteria: <br /> Test Result: Z Pass El Fail Z Pass [:] Fail ® Pass El Fail <br /> -------- ElPass ® Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW SPILL BUCKETS. 87 IS A QUAD FILL SUMP <br /> DIESEL BUCKET HAS CRACK IN IT. HMC to repair&retest. <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: (} M Date:02-17-15 <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 />