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DEC-123-2009 11 :48 AM GETTLER—RYAN INC, 925 551 4770 P. 02 <br /> i <br /> SWRt'B. January 3006 <br /> Spill Bucket Testing Report Form <br /> Thistarm is hrtended for use hr cnnhvrtors(,crJnrmir{e<4f7mrul tr.crinX n17 iS'T,tpill cvnluinmem.rlrncturae. 7'be completed/firm and <br /> printouts Pram testae(il applicuhlel, should he proyidrd ur thvfiwilig•orvrrer'operator for.enhmittul In the local reJ,aluJr7pc<rgenrr. <br /> I. FACILITY INFORMATION <br /> Facility Name_ PGR[: <br /> ------- -- I Date off Testing;; 1../10.09 <br /> FacilityAddress: <br /> _ 4040 West Lane -,---... . <br /> ----- le---.. ._—..- <br /> FacilityContac�. Michelle /_') ---- _—""'-"'---------- <br /> �__---� - Phanc. (20'))602-7038 <br /> Date Local Agency Was Notified of Testing : -- - 1 - -" - <br /> Name of Local Agency Inspector/r7prese•rr!durirrc 7v.r7Nr/;/: (!error Backus ---_- - - --- <br /> Z. TESTING_ CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc. -� <br /> Technician Conducting <• _..._---.-- - ..,. .... <br /> 1 est: Joc .,crnn 5;'.94)?. <br /> entce tsctNumber(CSLB Contracu7r "-- - -- -- <br /> - __ X ICCServicelbuh. SWRCBTank 'Iester Other/Speci� <br /> s): 220793 - - -----_..-•---------._�W<...:_�-_.— <br /> J. SPILL HUCKET TESTING INFORMATION <br /> Test Method I Ised: X H ydrostatic V -�- <br /> -- � acuum :Other <br /> Test Equipment Used: 'Pape Measure --- <br /> j Equipment Resolution: Itl(i' <br /> Identify Spill Bucket f4v Tank I • Diesel q <br /> Yumber, Sloped Product, e•Igl _ <br /> Bucket Installation'fypc: X Direct Bw•y Direct Bwv Direct Bury ..: Direct Bury J <br /> Contained in Sump i Contained is Sum Com.ained in Sum Contained in Sump <br /> -- — --... = . <br /> Bucket Diameter: 1 l•- ..._'..-- <br /> ucketDapth; Id's <br /> wait time between applying <br /> vacuum/water and start of test: 2nun <br /> 'est Start Tirtte(fi): I I a Sam <br /> Initial Reading(Rt): 11 W, <br /> fest End Time('1'F): 13:15pm - —Final Reading Ileading(Rr): II ',a' I <br /> ----- --- <br /> Test Duration(Ty-- fa: I it <br /> Change in in Reading(Rr-Rt): 0 <br /> Pass/Fail Threshold or 0 <br /> Criteria: <br /> Teat Raoult: X Pass ❑Fail —0pass- <br /> q Wail ❑ Pass 0 Fall ❑ Pass ❑Fall <br /> COulMenta -/Include informnitun nn rupuirc nrrrilr prior ry tes7inl,� and ruromn7endedJbllurv_:y7 frr7niled trx(s/ <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING:THIS TESTING <br /> I hereby certift that all the information corualned 117 this report A true, accurate, and is full compliance with legal requirements. <br /> Technician',Signature: __.....,. . Date; _ .. . . . <br /> State laws and regulations do not currontl) require testing to be pertirrmed by it qualified contractor. I fowever, local requirantent <br /> may be more stringent. <br />