Laserfiche WebLink
. ■(—��%/ P.O.Box 4208 <br /> All techPetry ' Sonora 53 95320 <br /> Ca:623541 A-Haz <br /> Phone:209-532-7320 <br /> Compliance without Compromise Fax:209-533-2650 <br /> mail(@alltechpetro.com <br /> w .alltechpetro.com <br /> Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco #658 Tracy Date of Testing: September 25, 2012 <br /> Facility Address: 3240 W. Grrant Line Rd Tracy CA <br /> Facility Contact: Troy Dominici Phone: 209-834-1427 <br /> Notification Date of Local Agency: 9/7/2012 <br /> Name of Local Agency Inspector:Thuy Tran <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ® Hydrostatic ❑ vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 87A 2 87 B 3 91 4 <br /> Bucket Installation Type: ❑ Direct Bury [I Direct Bury L3 Direct Bury ❑ Direct Bury <br /> ® In Sump In Sump In Sump ❑ In Sump <br /> Wait time between <br /> applying vacuum/water None None None <br /> and start of test: <br /> Test Start Time (T,): 8:15 8:15 8:15 <br /> Initial Reading (R): 2 1/2"Above Cap 1 7/8"Above Cap 1 3/4"Above Cap <br /> Test End Time (T,): 9:15 9:15 9:15 <br /> Final Reading (R,): 2 1/2"Above Cap 1 7/8"Above Cap 1 3/4"Above Cap <br /> Test Duration IT,-T): 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading (R,-R,): 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: ® Pass [-] Fail ® Pass ❑ Fail I ® Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br /> tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> l hereby certify that all the information contained in this report is true, accurate, and in full compliance with <br /> legal requirements. <br /> Technician's Signature. Date: 9/25/12 <br />