Laserfiche WebLink
Feb 0510 03:08p AFFORDA TEST . 209-744-0116 p.7 <br />S W RCB, January 2006 <br />Spill Bucket Testing Report Form <br />This form i intended jot• use by contractors performing annual testing of UST spill containment strucnrres. The completed form and <br />printoutsf m tests (if applicable), should be provided to the facility ownerloperator for submittal to the local regulatory agengi� <br />1. FACILITY INFORMATION <br />FacilityNarjie: TOKAY SHELL I Date of Testing: 1/5i10 <br />Facility Address: 420 W. KETTLEMAN LN. LODI, CA 95240 <br />Y Facility Cor tact: JAS Phone: 209-369-2790 <br />Ij Date Local Nency Was Notified of Testing :1229/09 <br />Name of Lccal Agency Inspector (rfpresent during testing): <br />_ 2. TESTING CONTRACTOR INFORMATION <br />Company me: AFFORDA TEST 416 2nd Street Galt, CA 95632 (209) 744-01 12 Fax: (209) 744-0116 <br />I Technician Conducting Test: ❑ Lyle D. Nimmo 0 Zane A. Nimmo ❑ David A. Winkler ❑ Felix G. Ramirez i <br />5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT <br />C:edentialsl: O :CC Service Tech. 0 SW'RCB Tank Tester <br />3. SPILL BUCKET TF:STINC INFORMATF7IN <br />Test Metho J Used: ® Hydrostatic ❑ Vacuum Other <br />Test Equipr tent Used: TAPE MEASURE, H2O <br />Equipment Resolution: 1:16" <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.. J <br />1 87 2 91 <br />3 100 OCT <br />4 DIESEL/ <br />WASTE OIL <br />Bucket Installation Type: <br />Bury <br />0 Direct Bury 0 Direct Bu <br />L1 Contained in Sump ❑Contained in Sump <br />0 Direct Bury <br />❑Contained in <br />Sum <br />0 Direct Berry <br />L1 Contained in <br />Sum <br />Bucket Diameter: <br />Bucket Depth: <br />f2 14 <br />13 <br />1 13 -- 11 <br />Wait time between applying <br />vacuumtwa er and start of test: <br />Test Start' ime (Tr): <br />930 930 <br />930 <br />930 -• 1200 <br />Initial Reading ([tr): <br />11 I/8 125/8 <br />121/2 <br />121,14 --- 105/8 <br />Test End Time (Tr): <br />1030 1030 <br />1030 <br />1030 --- 1300 <br />Final Reading (RF): <br />11 1/8 125/9 <br />12 1/2 <br />12 1:4 --- 105/8 <br />Test Duration (Tr - Tr): <br />HR HR <br />HR <br />HR --- HR <br />Change in eading (RF - Ri): <br />0 0 <br />0 <br />0 -- 0 <br />Pass/Fail T reshold or <br />Criteria: 1 <br />PASS <br />Test Result: <br />® Pass - ::Fail - ® Pass ❑ Fail <br />0 Pass ❑Fall <br />®Pass E] Fail <br />- (include information on <br />cr:x1 tr7CA17ON OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby ce tifv that all the information contained in this report is true, accurate, and in full compliance with legal requirements. <br />'s Signature: �EE� <br />Date: I-5-10 <br />'State lar I and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be n ore stringent. <br />