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ec-(R�ii.`.K COMP-M <br /> Spill Bucket Testing Report Form <br /> This form is intended for use b-v contructors 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.euhnnittal to the local regulators <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO Date of Testing: 10/30/2014 <br /> Facility Address: 550 W.Valpico Road,Tracy, CA 95376 <br /> Facility Contact: Edgar Rizkalli I Phone: (925)548-7910 <br /> Date Local Agency Was Notified of Testing: 10/21/2014 <br /> Name of Local Agency Inspector(f present during testing): Elena Manzo <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ECO-CHEK Compliance, Inc. <br /> Technician Conducting Test: Nik Zagorov <br /> Credentials': ®CSLB Contractor M ICC Service Tech. ® SWRCB Tank Tester ❑ Other(Specify) <br /> License Number(s): 958763 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used:Tape Measure/Level Change Indicator Equipment Resolution: 1/16"10.0025 <br /> Identify Spill Bucket (By Tank 1 87-E 2 87-W 391 4 Diesel <br /> ,Vunnber, Stored Product, etc.) <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® Contained in Sump ® Contained in Sump ® Contained in Sump ® Contained in Sum <br /> Bucket Diameter: 12 Inches 12 Inches 12 Inches 12 Inches <br /> Bucket Depth: 14 Inches 14 Inches 14 Inches 14 Inches <br /> Wait time between applying 10 Minutes 10 Minutes 10 Minutes 10 Minutes <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 11:55 AM 11:55 AM 02:05 PM 11:55 AM <br /> Initial Reading(RI): 13 518 Inches 13 3/8 Inches 0 13 1/4 Inches <br /> Test End Time(TF): 12:55 PM 12:55 PM 02:35 PM 12:55 PM <br /> Final Reading(RF): 13 5/8 Inches 13 3/8 Inches 0 131/4 Inches <br /> Test Duration(TF—TI): 60 Minutes 60 Minutes 30 Minutes 60 Minutes <br /> Change in Reading(RF-RI): 0 Inches 0 Inches 0 0 Inches <br /> Pass/Fail Threshold or 1/16 Inches 1/16 Inches 0.0025 1/16 Inches <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail I ® Pass ❑ Fail I ® Pass ❑ Fail 0 Pass ❑ Fail <br /> Comments— (include information on rel)uir.c trade prior to testing, and recommended folloir-up.for failed tests) <br /> Premium Tank Spill Bucket was retested with accelerated Level Change Indicator. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: O ©✓ Date: 10/30/2014 <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 />