COMPLIANCE INFO 2010 - 2015 - Laserfiche WebLink

Home Browse Search

SWRCB,January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ARP Mini Mart 76 1 Date of Testing: 03/21/2013 Facility Address: 25775 So.Patterson Rd.,Tracy,Ca.95376 Facility Contact: Neil Patel I Phone: (510)299-1219 Date Local Agency Was Notified of Testing: —pS_ Name of Local Agency Inspector(f present during testing): Thuy Tran 2. TESTING CONTRACTOR INFORMATION Company Name: Reliable Petroleum Services Inc. Technician Conducting Test: Guadalupe Sanchez Credentials: x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) License Number(s): 883706 5250451-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: xHydrostatic ❑ Vacuum ❑Other Test Equipment Used: Standard Tape Measure Equipment Resolution:N/A Identify Spill Bucket(By Tank 1 Tl: 87 Slave Fill 2 T2: 87 Master Fill 3 T3: 87 Syphon 4 T4: 91 Fill Number, Stored Product, etc.) Fill Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury x Contained in Sump x Contained in Sump x Contained in Sump x Contained in Sum Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 14 '/d' 13 '/2" 13 '/4" 13 '/z" Wait time between applying 1 minute 1 minute 1 minute 1 minute vacuum/water and start of test: Test Start Time(Ti): 12:22 p.m. 11:23 a.m. 11:28 a.m. 11:30 a.m. Initial Reading(RI): 13 1/8" 12" 12 1/8" 121/2" Test End Time(TF): 1:22 p.m. 12:23 p.m. 12:28 p.m. 12:30 p.m. Final Reading(RF): 13 1/8" 12" 12 1/8" 12 '/2" Test Duration(TF—T,): 1 hr lhr 1 hr 1 hr Change in Reading(RF-Ri): 0 0 0 0 Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" Criteria: Test Result: x Pass ❑Fail x Pass ❑ Fail x Pass ❑Fail x Pass ❑ Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) Replaced fill adapter, fill can and drain valve P-asket on 87 fill slave and fill can on 87 fill syphon CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I herehv certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signatur— Date 03/21/2013 ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.