Laserfiche WebLink
RECEIVE <br /> P.O.Box 4208 <br /> ����//MppAR 13 2014 SWRb S�a@ob <br /> Aliteeh ENVIRONMENTAL Phone:209-532-7320 <br /> compliance without compromiseFax:209-533-2650 <br /> HEALTH DEPARTMENT <br /> mail@alltechpetro.com <br /> w .aIltechpetro.com <br /> Spill Bucket Testing Report Form <br /> 1. FACILITY INFORMATION <br /> Facility Name: Costco#038 Stockton Date of Testing: March 12, 2014 <br /> Facility Address: 1616 Hammer Lane, Stockton CA <br /> Facility Contact: Rick Mederios Phone: 209-478-2040 <br /> Date Local Agency Was Notified of Testing : 2/20/14 <br /> Name of Local Agency Inspector (if present during testing): Jeff Wong <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Alltech Petro Inc, P.O. Box 4208, Sonora CA 95370. (209) 532-7320 <br /> Technician Conducting Test: Isaac Anderson <br /> Credentials ® CSLB Contractor ® ICC Service Tech. ® SWRCB Tank Tester ❑ Other (Specify) <br /> License Number(s): CSLB CA 62341 A-HAZ, ICC 8164912-UT, SWRCB 09-1749 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16 <br /> Identify Spill Bucket (By 1 87A Fill 2 87B Fill 3 91 Fill 4 Additive Fill <br /> Tank Number, Stored <br /> Product, etc.) <br /> Bucket Installation Type: El Direct Bury E:1 Direct Bury El Direct Bury E] Direct Bury <br /> ® In Sump In Sump In Sump In Sum <br /> Wait time between <br /> applying vacuum/water 0 0 0 0 <br /> and start of test: <br /> Test Start Time (T,): 8:30 8:30 8:30 8:30 <br /> Initial Reading (R,): 2.125'above Cap 2.25"above Cap 3.75" above Cap 2.75 " above cap <br /> Test End Time(TF): 9:30 9:30 9:30 9:30 <br /> Final Reading (Rr): 2.125"above Cap 2.25'above Cap 3.75"above Cap 2.75' above cap <br /> Test Duration (Tr—T,): 1.0 Hr. 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading (RF-R,): 0.0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16' 1/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ® Pass ❑ Fail 1 ® Pass ❑ Fail I ® Pass ❑ Fail <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br /> 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 in full compliance with legal requirements. <br /> Technician's Signature: Date: 03/12/14 <br />