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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(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name:ARCO AM PM Date of"besting: 05-26-10 <br /> Facility Address: 1711 E.Yosemite Manteca,CA. <br /> Facility Contact: Paul Singh Phone: 209-8234715 <br /> Date Local Agency Was Notified of Testing:05/07/10 <br /> Name of Local Agency Inspector(if present during testing): <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 El Vacuum ❑ Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank T1: 87 T2:89 T3: 91 <br /> Number, Stored Product, etc.2 FILL FILL FILL <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑ Direct Bury <br /> X Contained in Sump X Contained in Sump X Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 12%" 13'/" 13'/2" <br /> Wait time between applying 1 min 1 min 1 min <br /> vacuum/water and start of test: <br /> Test Start Time(T): 12:51 p.m. 12:53 p.m. 12:49 p.m. <br /> Initial Reading(RI): 11'/4" 125/811 11%" <br /> Test End Time(TF): 1:51 p.m. 1:53 p.m. 1:49 p.m. <br /> Final Reading(RF): 11'/," 12 5/8" 11%" <br /> Test Duration(TF—Ti): l h r l h r 1 h r <br /> Change in Reading(RF-R): 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" <br /> Criteria: <br /> Test Result: X Pass ❑ Fail X Pass ❑Fail X Pass ❑Fail ❑ 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 true,accurate,and in full compliance with legal requiremenm <br /> Technician's Signature: <br /> Date:5-26-10 <br /> State laws and reeulations do not currently reauire testing to be performed by a Qualified contractor.However, local requirements <br />