Laserfiche WebLink
t ' <br /> 1 F P �WR ,January 2006 <br /> Spill Bucket Testing Report Form ll' <br /> This form is intended for use by contractors performing annual testing of UST spill contain ept,structures. The completed�tt and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for sX�Z tal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name: ARCH AP PM I Date of Testing: 02-14-17 <br /> Facility Address: 4855 S HWY 99 STOCKTON CA 95205 <br /> Facility Contact: Gil or Nima Phone: 209-688-7036 <br /> Date Local Agency Was Notified of Testing:01-24-17 <br /> Name of Local Agency Inspector(ifpresent during testing): SAN JOAQUIN CO VIKI <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo ❑ Zane A.Nimmo ❑ David A. Winkler ® Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1/16 <br /> Identify Spill Bucket (By Tank 11 1 87 2 87 3 91 489 <br /> Number, Stored Product, etc. <br /> ❑Direct Bury ❑ Direct nstaElBury <br /> Bucket Illation Type: ❑ Direct Bury Direct Bury ®Contained in ®Contained in <br /> t ® Contained in Sump ® Contained in Sump SumpSum <br /> i Bucket Diameter: 11 11 11 11 <br /> Bucket Depth: 14 14 14 14 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 930 930 930 930 <br /> Initial Reading(R,): 13 13 13 13 <br /> Test End Time(TF): 1030 1030 930 930 <br /> Final Reading(RF): 13 13 12 12 <br /> Test Duration(TF—Tj): 1 HOUR 1 HOUR - - <br /> Change in Reading(RF-Rj): 0 0 1 1 <br /> Pass/Fail Threshold or - <br /> L <br /> iteria: <br /> est Result: ® Pass ❑ Fail ❑ Pass ❑Fail ❑ Pass ®Fail ❑ Pass ® Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW BUCKETS <br /> WAS ABLE TO SEE BUCKET LEAKING INTO SUMP <br /> REPAIRS TO BE DONE BY ELITE IV <br /> ALL BUCKETS MEASURED MORE THEN 5 GALLONS <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:02-14-17 <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 />