Laserfiche WebLink
9255517888 Line 15:02:21 01-14-2014 5/8 <br /> 67ETTLER-RYAN INC. _Job # 20-592714 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment stnictures. The Completed form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name: Arco 2186 Date of Testing: 1/8/2014 <br /> Facility Address: 3212 N California St Stockton,CA : <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: 12/31/2013 <br /> Name o1 Local Agency Inspector(i(present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION �- AL <br /> Company Name: Gettler-Ryan Inc.,6747 Sierra Court Suite J,Dublin,Ca.94568 Ph.#925-551-7555 <br /> Technician Conducting Test: Chris San Nicolas <br /> Credentials:(1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number: 220793 ICC Tech Number. 5296364-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic Vacuum Other <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 87 Vapor 2 87 Vapor 3 87 Vapor 4 91 Vapor <br /> Number,Stored Product, etc. <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sump <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 13.5" 13.5" 15" 12.5" <br /> Wait time between applying <br /> lOmin lOmin lOmin lOmin <br /> vacuum water and start of test: <br /> Test Start Time(Ti): 10:30 10:30 10:30 10:30 <br /> Initial Reading(Ri): 11" 11" 11-51, 10.5" <br /> Test End Time(Tf): 11:30 11:30 11:30 11:30 <br /> Final Reading(Rf) 11" 11" 11.5" 10.5" <br /> Test duration(Tf-Ti): 1hr lhr lhr 1hr <br /> Change in Reading(Rf-Ri): 0 0 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Results: X Pass ;Fail X Pass Fair X Pass Fail' X';Pass` Fail <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up forfailed tests) <br /> CERTFICATION 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: 1/8/2014 <br /> (1) 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 /> Received Time Jan. 14. 2014 1 : 53PM No. 5018 <br />