Laserfiche WebLink
l�&MER-RYAN INC. REtHVED 20-640102 <br /> FEB 0 9 2016 SWRCB.January 2006 <br /> Spill Bucket Testing Report Form AA�� <br /> This form is intended for use by contractors performing annual testing of UST spit tFg*&NTALompleted form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operato L`LI R PJTI regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Arco 6080 Date of Testing: 2/2/2016 <br /> Facility Address: 85 E Louise Ave.;Lathrop <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: 12/29/2015 <br /> Name Of ocaAgency inspector(ljpresent auring testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc..6805 Sierra Court Suite G,Dublin,C a.94568 Ph.#925-551-7555 <br /> Technician Conducting Test: Tim Adams <br /> Credentials:(I) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number: 220793 ICC Tech Number: 8205730 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hvdrostatic Vacuum 6ther <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 87 Fill 2 91 Fill 3 Diesel Fill 4 <br /> Number,Stored Product,etc.) <br /> Direct Bury Direct Bury Direct Bury Direct Bury <br /> Bucket Installation Type: <br /> Contained in Sump X Contained in Sump X Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 14" 14" 14" <br /> Wait time between applying <br /> linin linin Irvin <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 10:00 10:00 10:00 <br /> Initial Reading(Ri): 13" 13.5" 13" <br /> Test End Time(Tf): 11:00 11:00 11:00 <br /> Final Reading(Rf) 13" 13.5" 13" <br /> Test duration(Tf-Ti): I hr 1 lir I Itr <br /> Change in Reading(Rf-Ri): 0 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Results: X Pass Fail X Pass Fail Y Pass Fail Pass Fail <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTFICATION 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 requirements <br /> Technician's Signature: S Date: 2/2/2016 <br /> (1) 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 />