Laserfiche WebLink
Alltech Petro Inc. <br /> 17759 Buttercup Circle, Sonora, CA 95370 <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Contractor 623541 A-Haz <br /> ICC Technician: 8005930-UT <br /> SWRCB Tank Tester: 09-1749 CN <br /> alltechmai a-me.com IN <br /> Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco#658 Tracy Date of Testing: Tuesday, September 29,2009 <br /> Facility Address: 3240 W.Grrant Line Rd Tracy CA <br /> Facility Contact: Christine Hernandez Phone: 209-834-1427 <br /> Notification Date of Local Agency: <br /> Name of Local Agency Inspector:Michelle Henry <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ® Hydrostatic ❑ Vacuum Lj Other <br /> Test Equipment Used: [-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 Re` I 2 Reg 2 3 Prem 4 <br /> Lj Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> ® In Sum ® In Sum ® In Sum ❑ In Sum <br /> Wait time between applying None None None <br /> vacuum/water and start of test: <br /> Test Start Time(Tt): 12:10 9:15 9:15 <br /> Initial Reading(Rt): Top of Adapter Top of Adapter Top of Adapter <br /> Test End Time(TF): 13:10 10:15 10:15 <br /> Final Reading(RF): Top of Adapter Top of Adapter Top of Adapter <br /> Test Duration(TF—Tt): 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading (RF-Rj): 0.0 0.0 0.0 <br /> Pass/Fail Threshold or I/16" 1/16" I/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ® Pau ❑ Fail ® Pan ❑ Fail I ❑ Pau ❑ Fail <br /> Comments—(include in formation on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Cleaned out the seal between bucket and lid.On second attempt cleaned bucket under foam and replaced seal at bottom <br /> of drain valve. <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 compliunce with legal requirements. <br /> Technician's Signature: Date:9/29/09 <br />