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SWRCB,January 2006 <br /> 9. Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(f applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO #02186, CC 18022645 DateofTesting: 02/23/2010 <br /> Facility Address: 3212 N. CALIFORNIA @ ALPINE AVE. PTO # N-79, STOCKTON, CA, 95210 <br /> Facility Contact: MGR - KEVIN I Phone: (209) 941-2694 <br /> Date Local Agency Was Notified of Testing: 02/09/2010 <br /> Name of Local Agency Inspector(if present during testing): GARRETT BACKUS <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: JOEY MESA <br /> Credentials I: ❑X CSLB Contractor E ICC Service Tech. ESWRCB Tank Tester 1E Other(Specify) ICC SERVICE <br /> License Number: 5259458-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: El Hydrostatic ❑ Vacuum Other <br /> Test Equipment Used: TAPE MEASURE Equipment Resolution:1/8 " <br /> Identify Spill Bucket(By Tank t 1 REG FILL Z 1 REG FILL 3 2 REG FILL 4 3 PRE FILL <br /> Number, Stored Product, etc) <br /> 0 Direct Bury Direct Bury Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ❑x Contained in SumpXQ Contained in Sump ❑R Contained in Sump Q% Contained in Sump <br /> Bucket Diameter: 10 " 10 it 10 " 10 " <br /> Bucket Depth: 13 1/2 13 1/2 " 13 1/2" 13 1/2 " <br /> Wait time between applying 5 MIN. 5 MIN. 5 MIN. 5 MIN. <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 11:30 11:30 11:30 11:30 <br /> Initial Reading(R1 ): <br /> 12 " 12 It <br /> 12 " 12 ' <br /> Test End Time(TF): 12:35 12:35 12:3 5 12 3 5 <br /> Final Reading(RF ): <br /> 12 It 12 " 12 If 12 " <br /> Test Duration: 60 MIN. 60 MIN. 60 MIN. 60 MIN <br /> Change in Reading(R F-RI ): <br /> Pass/Fail Threshold or PASS PASS PASS PASS <br /> Cl <br /> Test Result: El Pass 0 Fail Pass 1:1 Fail a Pass El Fail El Pass D Fail <br /> Comments- (include information on repairs made prior to testing, and recommended follow-up fbr jbiled tests) <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: 11/`� Date: 02/23/2010 <br />—i <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 />