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Nov 14 12 11:43a Reliable PetroleurnA 209-845-8953 p.13 <br /> S WRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intendedi r use by contractors performing annual testing of USTspill containment structures. The completed form and <br /> printouts from tests ( plicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Chevron Date of Testing: 10/152012 <br /> Facility Address: 508 Charter Way,Stockton,Ca.95206 <br /> Facility Contact: Rinku Phone: (209)465-3440 <br /> Date Local Agency We Notified of Testing: to—,73-I Z <br /> Name of Local Agency nspector(Ifpresent during testing): Stacy Rivera <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services,Inc. <br /> Technician Conducting est: Guadalupe Sanchez <br /> Credentials': x CSLE Contractor x ICC Service Tech. 0 SWRCB Tank Tester 0 Other(Specify) <br /> License Number(s): 883706 5250451 <br /> 3. SPILL•BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic ❑Vacuum 0 Other <br /> Test Equipment Used: tandard Tape Measure Equipment Resolution:N/A <br /> Identify Spill Bucket( Tank 1 Tl:87 Fill 2 T2:91 Fill 3 T3: Diesel Fill 4 T4: <br /> Number,Stored Produ , etc. <br /> Bucket Installation T)T : x Direct Bury x Direct Bury x Direct Bury Direct Bury <br /> Contained in Sump Contained in Surtp Contained in Sump Contained in Sum <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 13" 13 'V, 12%" <br /> Wait time between app] ing I minute 1 minute 1 minute <br /> vacuumtwater and start 'test _ <br /> Test Start Time(TI): 9:30 am. 9:30 a.m. 9:31 am. <br /> Initial Reading(Rt): 12 Y4" 12 Y:" 11 %z" <br /> Test End Time(TF): 10:30 am. 10:30 a.m. 10:31 a.m. <br /> Final Reading(RP): 121/4" 12 %" 11 '/," <br /> Test Duration(TF—TO: 1 hr 1 hr 1 hr <br /> Change in Reading(RF R�: 0 0 0 <br /> Pass/Fail Threshold or 1116" 1116" 1116" <br /> Criteria: <br /> Test Result: x Pass D Fail x Pass 0 Fail x Pass 0 Fail Pass 0 Fail <br /> Comments —(inclu !nformation on repairs made prior to testin&and recommended allow-up for jailed tests) <br /> CERTIF CATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that at the information contained in this report is true,accurate,and In full compliance with legal requirements. <br /> Technician's Signature Date 10/152012 <br /> State laws and regulatio s do not currently require testing to be performed by a qualified contractor.However, local requirements <br /> may be more stringenL <br />