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Apr 28 14 04:00a Reliable Petroleum 2098458953 p.16 <br /> 04/28/2014 7:110 FAX 19252, 171 Guadalupe Sanchez la0015/0075 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> TAis form is intended for use by cuntracrorr performing annual tearing of UST spill cuntainment structurer. The completed form and <br /> printoutsfrom teas(rf applicable),should he provided to the faodity owner/operator for submittal to the local regulatory agenW <br /> 1. F'ACILIT'Y INFORMATION <br /> Facility Name: ARP Mini Mart 76 Acte of Testing: 0388/2014 <br /> Facilky Address: 25775 So.Patterson Rd.,Tracy, Ca,95376 <br /> Facility Contact; Neil Patel I Phone: (510)299-1219 <br /> Date Local Agency Was Notified oCTesting: p..3--Id— <br /> Name of Local Agency Inspector orf present during testing): Thuy Tran <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> CmdentiaW.- x CSLB Coattactor x ICC Service Tech. ❑SWRCB Tank Tester l!Other(Specify) <br /> License Number(s): 883706 5250451-L'T <br /> 3. SPILL BUCKET TIESTING INFORMATION <br /> Test Method U%ed: xHydrostatic 0 Vacuum ❑Other <br /> Test Equipment Used: Standard TVe Measure Equipment Resulutitm:N/A <br /> Identify Spill Bucket(By Tank 1 TI:87 Slave Pill 2 T2: 87 Master Fill 3 T3: 87 Siphon 4 T4:91 FUI <br /> Number,Stored.Producr, etc.) Mil <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> x Contained in Sump x Contained in gap x Contained in Sump x Con Wr.ed in Sum <br /> liuoket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 14" 13 '!" 13 3/4" 13 W <br /> Wait time between applying 1 minute 1 minute 1 minute 1 minute <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 11:46 am. 11:46 a.m. 11:46 a.m. 11:46 a.m. <br /> Initial Reading(R,): 12 3/" 12" 12 318" 12 3!8" <br /> Test End Time(TF): 12:45 p.m. 12:46 p.rtt. 12:46 p.m. i2:46 p.m. <br /> Final Reading(Rr): 12'/," 12" 12 3/8" 12 318" <br /> Test Duration(TE—Ti): I hr 1 hr 1 ter 1 hr <br /> Change in Reading(Rr-R,)- 0 0 0 0 <br /> Pass/Fail Threshold or 1116" 1!16" 1/16" 1116" <br /> Criteria: <br /> Test Result: x Pass ❑Fasl x Pass ❑Fail x Pass ❑Fail t Pass 0 Fail <br /> Comments—(incbede information on repairs made Friar to testing,and recornmendedfollow- fo D <br /> IL"%JL.1 V <br /> AFH 1T-- <br /> TAL HEALTH <br /> UffyARTMENT- <br /> CERTIFICATION OF TECHNICIAN RFSPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the infunwdon contofned in Wt report is true,aeearate,and in full ctmrpliance wick legal requirenimn. <br /> echnician's Sig=nature —�� c � _-- �� Date 03128/2014 <br /> Statc laws and regulations do not currently require testing to be performed by it qualified contractor.However,10Cx1 requirements <br /> may be more stringent. <br />