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Apr 27 12 12:25p Reliable PetroleumA 209-845-8953 p.6 <br /> I <br /> WRCB,January 20D6 <br /> Spill Bucket Testing Report Form <br /> This form is intendedfr use by contractors performing annual testing of L�_57spilt contoinment structures. T completedform and <br /> printouts from tests(rf ipplicablel,should be provided to thefacility owner.?.perarorfor submirral to the local egulatory agency. <br /> I. FACILITY INFORNLATION <br /> Faci'.ity Name: Arco : Date of Testing: 0327/2012 <br /> Facility Address: j 1711 E.Yosemite Ave.,Manteca,Ca.95336 <br /> Facility Contact: Sonnie Phone: (209)451-8441 <br /> Date Local Agency Wa Notified of Testing: <br /> Name o`Local Agency I h3peotor(ifpresent during testing): Muniappa Naidu <br /> I <br /> 2. TESTING CONTRACTOR ENFORN ATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting lest: Guadalupe Sanchez <br /> Credentials': x CSL$ ontractcr x ICC Service Tech. C SWRCB Tank Tester d Other(Specif)) <br /> License Numbe-{s): 883706 5250451-UT <br /> 3. SPALL BUCKET TESTING INFORM <br /> ATION <br /> Test Method Used: j xHydrostatic ❑Vacuum Q Other <br /> Test Equipment Used: S an dud Tape Measure Equipment Resolution:N <br /> Identify Spill Bucket(By Tank I TI: 87 Fill 2 T2:89 Fill 3 T3: 91 Fill 4 T4: <br /> INumber, Stored Product, etc <br /> Bucket Instatlation Type Direct Bury Direct Bury Direct Bury Direct Bury <br /> j s Contained in Surnp x Contained in Sump i x Contained in Surnp Fj Contained in Sum <br /> 13 <br /> Bucket Uatneter: j 12" 12" 12" <br /> Bucket Depth: 12'x;" 1; 5/8" 13 !/0 <br /> Wait dime between apply ng <br /> vacuumfwater and start o test: l nittute I minute I minute: <br /> Test Start Time fT): j 1-06 p.m. 12:25 p.m. 1:07 p.m. <br /> Initial Reading(Rj): 12 '/1' 11 7/8" <br /> 11 SiV <br /> i est End Time(Tr): j 2:06 p.m. 1:25 p.m. 2:07 p.m_ <br /> Final Reading (RF): 12'/a" 11 7/81' 11 Sib" <br /> Test Duration(Tr—Ti): 1 hr I hr 1 hr <br /> Change in Reading(RF-1 0 0 <br /> Pass/Fail Threshold or 1/16- 1/16" <br /> Criteria: i 16" <br /> —Test Result: z Pass C Fail x Pass ] Fail c Pass [I Fail Pass O Fail <br /> Comments—(include j"formation on repairs made prior to teslir , and recommend,-dfol'ow-u for failed t is) <br /> CERTIFICkTION OF TECFFNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all 1#1e information contained in this report is true,accurate,and in full compliance w' legal requlrenretrts. <br /> TechrLcian's Signature: Date 03,'27721112 <br /> Sate laws and reguiatians o not currently require testing to be performed by a qualified contractor. However,l cal requirements <br /> may be more stringent. <br />