Laserfiche WebLink
' SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> Thais for is intended,for use GP contractors performing annual testing of 1 hST.spill containment structures. The eompleted.form and <br /> printotrl from tests((f applicable), .should be provided to thefacifity owner/operatorfor,submilial to the local regulatory agency, <br /> L FACILITY INFORMATION <br /> r--K—atne <br /> amc_ Systems Transport Date ofTestind: May 17,2010 <br /> ddress_ 707 E.Roth Road, French Camp,CA 95231 <br /> ontact: Steve Tacker Phone; 209.983.8654 <br /> al Agency Was Notified of Testing ; May 17,2010 <br /> Local Agency Inspector(tf presen!during testing):): Thuy Tran <br /> 2. TESTING CONTRACTOR TNFORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPMENT CO. INC. <br /> Technician Conducting•Post: Eric Mnlgaard <br /> Credentials': CSLCo Contractor (x) ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Sped) <br /> License Numher(s): TCC 5250200 UT <br /> 3. SPTU BUCKET TESTING INFORMATION <br /> 'rest Method Used: (x)Hydrostatic ❑ Vacuum F Other _ <br /> Test Equipment Used: Tape Equipment Resolution: 1/32 in <br /> Identify Spill Bucket....... . <br /> (13y Tank 1 2 3 4 <br /> Number, Stnredl�rod+tct, etc. DIESEL TANK <br /> Bucket Installation Type: x Direct Bury n Direct Bury D Direct Bury r1 Direct Bury <br /> [I Contained in Sump Cont tined in Sum Ll Contained in Sump 1:1 Contained in Sump <br /> Bucket Diameter, 12 INCH <br /> Bucket Depth: 11 INCH —� <br /> Wait tim be,etwecn applying 5 MIN. <br /> vacuum/w er and start of test: <br /> Test Start lime Tor <br /> :50 a.m. <br /> Initial Readin_( 1 IN <br /> 'Test Frid Time :50 a.m. <br /> Final Reading(RINCH <br /> Test Duration('1HOURChange in Rcadi - <br /> Pass/Fail ThreshSSCriteria:'fest Result: (X) Pass C1 Fail d Pass n Fail Cl Pass 0 FRII 17 Pass ❑ Fail <br /> ComMent9— (include information on repairs made prior to testing, and recommended foUovw for failed tests) <br /> CF.R'1'IFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TRSTING <br /> [hereby certf/p that all the inforntarinn contained/n ibis repos i true,accurate, rind in,fufl canpdinnce with legal requirements. <br /> 11 <br /> T'echnician's Signature; Tric No(fctard '� Date: May 17,2010 <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 /> Page 4 of 4 <br />