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Violation 206 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This furca is intended for use bif conU-achus perloc-ming acucnal leslurg o/'UST spill containmern sN neon e c. The completed lbrin and { <br /> t prinlvnls,/rnni fists(i/crpplicuhlc),shourld be provided to lhefacilifi oir1100AywratorTu stchurinal to the local regulatory el enrr. <br /> 1. FACILITY INFORMATION <br /> Facility Name: CRUISERS MANTECA BP29 Date of Testing: 8125116 <br /> Facility Address: 1137 W LATHROP <br /> , <br /> Facility Contact: MANICA intone: 209-824.2760 <br /> Date Local Agency Was Notified of Testing: NA <br /> Name of Local Agency Inspector(if presenl chwing lusting) ELANA <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name L.C.SERVICES j <br /> Technician Conducting Test: GABRIEL VENEGAS <br /> Credentials': ❑CSLB Contractor x ICC Service Tech. r SWRCB Tank fester D Other(.Speclj) _ I <br /> License Number(s): <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test.Method Used: X--Hydrostatic H Vacuum t]Other <br /> Test Equipment Used-WATER Equipment Resolution:'TAP I� <br /> Identify Spill Bucket(IIt, an 1 87 2 91 3 DSL 4 <br /> Nuonhec•, Stored Product, etas i <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury 1-1 Direct Bury fj <br /> X Contained in Sump X Contained in Sump Contained in Sump 1'.I Contained in Sunk <br /> Buret Diameter: 12" 12" 12" <br /> Bucket Deptlt: 13" 13" 13" { <br /> Wai%time between applying 5 MIN 5 MIN 5 MIN <br /> vacuumhvater and start of test: <br /> Test Stan Time(Tn): 130 PM 130 PM 130 PM <br /> Initial Reading <br /> (111): 14" 15" 141/4" <br /> Test End Time(Tl:): 230 PM 230 PM 230 PM <br /> Final Reading(Rr): 14" 15" 141/4" <br /> Test Duration(TI:—Tt): IHR I I IR 1 I R <br /> Change in Reading(RI-Ri): NONE NONE NONE <br /> PassiFaiI Threshold or <br /> Criteria: NONE NONE NONE i <br /> Test Result: X Pass ❑Fail X Pass D Fail X Pass Q(:ail Pass ❑Fail ! <br /> Comments—linchude h?1bi•nuaion on r•el)ah--tnade prior to testin�, and recau,nrended.li�llun.np Ja,�aued rests) <br /> , <br /> MAY <br /> CERTIFICATION OFTECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TPSTING <br /> 1 hereby cert j,that the infornrallun contained in this report is true,tr curule,trod in ftrN cwnpliurucc with legal requirements. <br /> { <br /> Technician's Signature:_ _ -- � --- Date: < <br /> 'State laws and regulations do not currently require testing to he performed by a qualified contractor. However,local requirements <br /> may he more stringent, <br />