Laserfiche WebLink
®GErrLER-RYAN INC. GR Job# 1720-4467 <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 structures. 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 3 2 018 <br /> Facility Address: 3212 N. California Stockton 95204 <br /> Facility Contact: Daryl Lee Phone: 415 . 9 0 2 .5 0 8 9 <br /> Date Local Agency Was Notified of Testing: <br /> Name of LocalAgency Inspector i present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc.,6805 Sierra Court,Suite G,Dublin,Ca.94568 Ph.#925-551-7555 <br /> Technician Conducting Test: Alexander Tate <br /> Credentials:(1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number: 210793 ICC Tech Number: 8196693-VT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Me od Used: Hydrostatic Vacuum Other <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1/16" <br /> I enhfy Spill Bucket(By Tank 1 ------y_. 2 - g -_—— 4 <br /> Number,Stored Product,etc) <br /> 87-1 F i 11 87-2 F i 11 87-3 F ill 91 Fill <br /> Bucket Installation Type: Direct Bury LjDirect Bury LjDirect Bury irect Bury <br /> Contained in Sump OX Contained in Sump QX Contained in Sump OContained in Sump <br /> Bucket Diameter: 12 12 12 12 <br /> Bucket Depth: 12 12 12 12 <br /> Wait time between applying <br /> vacuum/water and start of test: 5 mins 5 mins 5 mins 5 mins <br /> Test Start Time(Ti): 10:00 10 : 0 0 10: 0 0 10 : 00 <br /> Initial Reading(Ri): 1111 11 1/2 11 3/8 10 7/8 <br /> Test End Time(Tf): 11: 0 0 11 : 0 0 11:0 0 11: 0 0 <br /> Final Reading(Ro 1111 1111 1111 10 7/8 <br /> Test duration(Tf-Ti): 1 hr 1 hr 1 hr 1 hr <br /> Change in Reading(Rf-Ri): 0 0 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 1 0 1 0 <br /> Test sults: EWSSS L&I IPsss silI Ell'us LjFail I OP"s Fail <br /> Comments-(include information on repairs made prior to testing,and recommended follow-up for failed tests) <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is hue,accurate,and in full compliance with legal requirements <br /> Technician's Signature: Date: 1/3/2018 <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 />