Laserfiche WebLink
IECFIVED <br /> ,i!J L 19 MWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containmMAZW K� %m leted form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for sh1Fn1MTihld W:M a7 tory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: FAST AND EASY I Date of Testing: 06-11-18 <br /> Facility Address: 1399 E YOSEMITE AVE MANTECA,CA 95336 <br /> Facility Contact: DEEP Phone: 209-823-3460 <br /> Date Local Agency Was Notified of Testing:05-24-18 <br /> Name of Local Agency Inspector(if present during testing): SAN JOAQUIN CO ZUNA <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Gait,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑Ed Stearns ❑ Zane A.Nimmo ❑ David A.Winkler ® Felix G.Ramirez <br /> 8883080-UT 8883064-UT 8883059-UT 8883072-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 1 87 2 91 3 DIE 4 <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: ® Direct Bury ® Direct Bury <br /> ® Direct Bury E] Direct Bury <br /> ❑ Contained in Sump ❑Contained in Sump EI Contained in [I Contained in <br /> Sump Sum <br /> Bucket Diameter: 1 1 I 1 11 <br /> Bucket Depth: 13 13 13 <br /> Wait time between applying - <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 915 915 915 <br /> Initial Reading(Ri): 12 12 12 <br /> Test End Time(TF): 1015 1015 1015 <br /> Final Reading(RF): 12 12 11 <br /> Test Duration(TF—Ti): 1 HOUR 1 HOUR 1 HOUR <br /> Change in Reading(RF-R,): 0 0 1 <br /> Pass/Fail Threshold or <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 tests) <br /> OPW BUCKETS <br /> ALL BUCKETS HOLD 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:06-11-18 <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 />