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Spill Bucket Testing Report Form <br /> NOV 1 8WJJ B,January 2006 <br /> 20 <br /> This form is intended for use by contractors performing annual testing of UST spill containment strutew r��g�I��#41 and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for Ramsr�ldroty agency, <br /> 1. FACILITY INFORMATION DEPA. �N1 NT <br /> Facility Name: Arco Date of Testing: 10/20/2016 <br /> Facility Address: 1340 Colony Rd,Ripon,Ca.95366 <br /> Facility Contact: Ranjeet Phone: (209)5794014 <br /> Date Local Agency Was Notified of Testing: 10/M016 <br /> Name of Local Agency Inspector(ifpresent during testing): Vickey McCartney <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Diamond Petroleum Services, Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> LicenseNumber(s): 1005444 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank I Tl:87 Fill West 2 Tl:87 Fill East 3 T2: 91 Fill 4 T3: Diesel Fill <br /> Number,Stored Product, etc.) <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> x Contained in Sump x Contained in Sump x Contained in Sump Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 15" 14" 14%" 15 '/." <br /> Wait time between applying 1 minute I minute I minute I minute <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 2:18 p.m. 2:18 p.m. 2:00 p.m. 2:00 p.m. <br /> Initial Reading(Rt): 14" 13 7/8" 13 5/8" 13 3/8" <br /> Test End Time(TF): 3:18 p.m. 2:18 p.m. 3:00 p.m. 3:00 p.m. <br /> Final Reading(RF): 14" 13 7/8" 13 5/8" 13 318" <br /> Test Duration (TF—Ti): 1 hr Ihr 1 hr I hr <br /> Change in Reading(RF-Rj): 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: x Pass D Fail x Pass D Fail x Pass ❑Fail x Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-un for failed tests) <br /> Replaced spill bucket O-rinla in the 87 fill Inspector on site <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all Nue Information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signatu • , :::A:�,. �".,, Date 10/20,2016 <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 />