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Spill Bucket Testing Report Form SWRCB,January 2006 <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 /> I. FACILITY INFORMATION <br /> Facility Name: MAIN STREET ARCO#82617 <br /> Facility Address: 1100 S.Main Street,Manteca CA 95337 Date of Testing: 03-25-10 <br /> Facility Contact: Jasbir Chadda Phone: 209-825-6784 <br /> Date Local Agency Was Notified of Testing: 03-22-10 <br /> Name of Local Agency Inspector(fpresent during testing): Thuy Tran <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': X CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank Tl: 87(West)Fill T1: 87(East)Fill T2: 91 Fill T3: 89 Fill <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury Direct Bury ❑Direct Bury <br /> X Contained in Sum X Contained in Sum X Contained in Sum X Contained in Sum <br /> Bucket Diameter: 12" 1299 12" <br /> 12" <br /> Bucket Depth: 13" 15%11 151/211 <br /> 13'/:" <br /> Wait time between applying <br /> vacuum/water and start of test: 1min. lmin. lmin. lmin. <br /> bFinalReading(RF): <br /> rt Time(Ti): 12:26p.m 12:26p.m 12:28p.m 12:32p.m <br /> P• <br /> eading(Ri): 11 1/8" 137/811 133/819 115/81, <br /> Time(TF): 1:38p.m 1:38p.m 1:37p.m 1:37 m <br /> adin R p'g( F) I1 1/8" 137/8" 13 3/8" 115/8"ration(TF—Ti): 1hr. 12min. 1hr. 12min. lhr.9min. :1h :5m .in Reading(RF-RI): 0 0 0 l Threshold or <br /> 1/16" 1/16" l/16"Test Result: X Pass ❑Fail X Pass ❑Fail X Pass ❑Fail X Fail <br /> Comments— (include information on repairs made prior to testing, and recommended ollow-u or ailed 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: _ Date:03-25-10 <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 />