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SWRCB, January 2002 Page of <br />a eD1 tnVTi'UFTT.T. CONT ATNMFNT BOXL <br />Commenis — (include information on repair's made prior to testing, and recommended follow-up for failed tests) <br />Please direct any comments regarding this form to: <br />SWRCB UST Program, Attn: Scott Bacon <br />1001 "1" Street, Box 944212 <br />Sacramento, CA 95814 <br />Phone: (916) 341-5873, Fax: (916) 341-5808 <br />e-mail: bacons@cwp.swreb.ca.gov <br />Facility is Not Equipped With Spill/Overfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ <br />Test Method Developed By: <br />❑ Spill Bucket Manufacturer <br />Industry Standard ❑ Professional Engineer <br />❑ Other (Spec) <br />Test Method Used: <br />❑ Pressure ❑ <br />Vacuum Hydrostatic <br />❑ Other (Spec) <br />Test Equipment Used: `�j—fir( <br />�t , � �. - v <br />Equipment Resolution <br />16 ' <br />: Y <br />y,•;y:{ H> -. Si({:I:F�{{ IY'iFVelr31 IN? I:�i�+Ff}Y.I '�i�1."r�ICM4:L�rf'.:5'dfiLl�trlt.%1/ H!i�_F4FG7!�'!N'�Y1NG}i3+7%i�'211?d`�rv"'�F.fY�C'n;;..w.iFyM�1S RW;nM.��iiFYi1L'I�EFf'af ii:m �7`:k�YRY1�i'u.1�iRFi�� . ?�. S <br />F 0" nPillBox# 'r S illBox# DICS S�I!EIlY'Bu{�ohx.# Spill Box# <br />;' <br />n`;i"r?.'slt,°u'��lFn` <br />kfi�s{ •!•;sal <br />. <br />Bucket Diameter: <br />to < o <br />1 <br />I <br />Bucket Depth: <br />l5 <br />1 f <br />5 <br />Wait time between applying <br />pressure/vacuum/water and <br />starting test: <br />Test Start Time: - <br />101 fl <br />j 0 7 <br />(0rD <br />00 fn <br />Initial Reading (Rj): <br />Test End Time: <br />Final Reading (RF): <br />Test Duration: <br />Change in Reading (RF-Rj): <br />QJ <br />Pass/Fail Threshold or <br />f <br />Criteria: <br />' <br />Test Result: <br />❑'Pass ❑ Fail <br />dPass ❑ Fail ❑ Pass [IFail <br />❑ Pass F-1Fail <br />Commenis — (include information on repair's made prior to testing, and recommended follow-up for failed tests) <br />Please direct any comments regarding this form to: <br />SWRCB UST Program, Attn: Scott Bacon <br />1001 "1" Street, Box 944212 <br />Sacramento, CA 95814 <br />Phone: (916) 341-5873, Fax: (916) 341-5808 <br />e-mail: bacons@cwp.swreb.ca.gov <br />