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' 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(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: MAIN STREET ARCO Date of Testing: 03-30-09 <br /> Facility Address: 1100 S.Main Street Manteca CA <br /> Facility Contact: Jesse Chadda I Phone: 209-825-6784 <br /> Date Local Agency Was Notified of Testing: 03-20-09 <br /> Name of Local Agency Inspector(rf present during testing): Muni Naidu <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 Measure Tape Equipment Resolution: <br /> Identify Spill Bucket(By Tank Tl: 87 Unleaded T1: 87 Unleaded T2: 91 Fill T3: 89 Fill <br /> Number, Stored Product, etc.) Fill West Fill East <br /> Bucket Installation Type: Direct Bury ❑ Direct Bury G Direct Bury ❑Direct Bury <br /> X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum <br /> Bucket Diameter. 12" 12" 12" 12" <br /> Bucket Depth: 141/2" 15%" 151/4" 15%z" <br /> Wait time between applying <br /> vacuum/water and start of test: 1 min. linin. lmia. linin. <br /> Test Start Time(Tj): 9:45a.m 9:45a.m 9:43a.m 9:46a.m <br /> Initial Reading(Rj): 121/4" 13%:" 13 3/16" 13 '/4" <br /> Test End Time(TF): 10:55a.m 10:54a.m 10:55a.m 10:54a.m <br /> Final Reading(RF): 121/4" 13%:" 13 3/16" 13 ''/4' <br /> Test Duration(TF—Ti): 1hr.10min. 1hr.9min. lhr.12min. l hr.8min. <br /> Change in Reading(RF-RO: 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: X Pass ❑Fail X Pass ❑ Fail X Pass ❑ Fail X Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is trae,accarate,and in fall compliance with legal requirements. <br /> Technician's Signature: _ c Date:03-30-09 <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 />