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SWRCB,January 2006 <br /> SpilTBucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO I Date of Testing: 11/30/2011 <br /> Facility Address: 4855 S.State Route 9, Stockton,Ca.95215 <br /> Facility Contact: Gill Phone: . (209)481-7445 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(fpresent during testing): Stacy Rivgra <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials: x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): 883706 . 5250451 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xHydrostatic ❑Vacuum q Other. <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 Tl: 87 Fill SE 2 Tl: 87 Fill NE 3 T2: 89 Fill 4 T4: 91 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 x Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 13 '/d' 133/4" 13'/a" 13'/4 <br /> Wait time between applying I minute 1 minute I minute I minute <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 1:36 p.m. 3:04 p.m. 1:37 p.m. 1:35 p.m. <br /> Initial Reading(Ri): 117/8" 12'/." 12'/4" 12 '/4" <br /> Test End Time(TF): 2:36 p.m. 4:04 p.m. 2:37 p.m. 2:35 p.m. <br /> Final Reading(RF): 117/8" 12'K" 12 YT 12%4" <br /> Test Duration(TF-Tj): 1 hr lhr 1 hr 1 hr <br /> Change in Reading(RF-Rj): '0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1 1/16" 1/16" <br /> Criteria: <br /> Test Result. x-Pass ❑Fail x Pass `D Fail " s Pass D Fail a Pass ' D Fail , <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up forfailed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> /hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signa Date 11130/2011 <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 />