COMPLIANCE INFO 2016 - 2018 - Laserfiche WebLink

Home Browse Search

.d S i11 Bucket Testing Report Form FOMftuary 2006 Thisform is intended or use b contractors performing annual testingo UST spill containments ,�p� nd f f y P � �o thefacility owner/o erator or submittal to, t .�I Tl�� gency. printouts from tests (f applicable), should be provided f ry P f w A i-rr Ti`.7 T%TV"1]M A TT"N A. 1' 1'1%.JL1 i A FFacillity Name: WEST LANE CHEVRON Date of Testing: 09-29-15 Address: 4747 N WEST LANE STOCKTON CA 95210 Contact: RAVINDER Phone: 209-472-1639 ocal Agency Was Notified of Testing :09-22-15 Name of Local Agency Inspector (f present during testing): SAN JOAQUIN CO 2. TESTING CONTRACTOR INFORMATION Company Name: AFFORDA TEST 4162 nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 11 Technician Conducting Test: ❑ Lyle D. Nimmo ❑ Zane A. Nimmo E] David A. Winkler ® Felix G. Ramirez 5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT Credentials': ® ICC Service Tech. ® SWRCB Tank Tester -) o"YT r arTrIrV9r TFCTTNf INFORMATION Comments (include information on repairs made prior to testing and recommended follow-up for jauea rewss OPW BUCKETS CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: Date:09-29-15 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. J. JI 1LL "%j%—Xu .a — -- ® Hydrostatic ❑ Vacuum ---- - ❑ Other Test Method Used: Test Equipment Used- TAPE / H2O Identify Spill Bucket (By Tank Number, Stored Product, etc. Bucket Installation Type: 1 87 2 87 ❑ Direct Bury ❑Direct Bury ® Contained in Sump ® Contained in Sump Equipment Resolution: 3 91 Direct Bury E]® Contained in Sum 1/16 4 ❑Direct Bury ❑ Contained in Ste, Bucket Diameter: 11 11 11 13 9000 13 _ 900 13 - 900 Bucket Depth: Wait time between applying vacuum/water and start of test: Test Start Time (Tt): Initial Reading (RI): 12 12 12 Test End Time (TF): 1000 1000 1000 12 1 HOUR 12 1 HOUR 12 1 HOUR � Final Reading ): (RF Test Duration (TF — Tr): 0 ® Pass E] Fail 0 0 Change in Reading (RF - RI): - ®Pass ❑ Fail - ® Pass El Fail ❑ Pass ❑ Fail Pass/Fail Threshold or Criteria: Test Result: Comments (include information on repairs made prior to testing and recommended follow-up for jauea rewss OPW BUCKETS CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: Date:09-29-15 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.