Laserfiche WebLink
SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intendedfor use by contractors performing annual testing of USTspill containm838ent structures. The completedform <br /> and printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory <br /> agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: TEXACO Date of Testing: 6/29/2009 <br /> Facility Address: 1405 CALIFORNIA ST,ESCALON,CA,95320 <br /> Facility Contact: CHOCO I Phone: 209-838-7674 <br /> Date Local Agency Was Notified of Testing: 6-23-09 <br /> Name of Local Agency Inspector(fpresent during testing): MUNI <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: SST-SERVICE STATION TESTING <br /> Technician Conducting Test: HEATH MCEVER <br /> Credentials': 0 CSLB Contractor -ICC Service Tech. s2'SWRCB Tank Tester E Other(Spec) <br /> License Number(s): 04-1677 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: A Hydrostatic 0 Vacuum 0 Other <br /> Test Equipment Used: WATER Equipment Resolution: INCHES <br /> Identify Spill Bucket(By Tank 1 87 2 91 3 DSL 4 <br /> Number,Stored Product, etc. <br /> Bucket Installation Type: 73 Direct Bury 0 Direct Bury 0 Direct Bury 0 Direct Bury <br /> Contained in Sum 0 Contained in Sum 0 Contained in Sum 0 Contained in Sum <br /> Bucket Diameter: I 1 11 11 <br /> Bucket Depth: 13 13 14 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 0936 1116 1200 <br /> Initial Reading(R,): 11.5" 12" 13 1/8" <br /> Test End Time(TF): 1036 1216 1300 <br /> Final Reading(RF): 11.5' 12" 13 1/8" <br /> Test Duration(TF—T,): 1 HR 1 HR 1 HR <br /> Change in Reading(RF-R,): 0 0 0 <br /> Pass/Fail Threshold or 0 0 0 <br /> Criteria: 11 <br /> Test Result: 11 ® Pass 0 Fail A Pass 0 Fail ® Pass 0 Fail 0 Pass 0 Fail <br /> Comments—(include information on repairs made prior to testing and recommended follow-up for failed tests) <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 infull compliance with legal requirements. <br /> 1114 <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 />