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UfTTLER-RYAN INC. IEGEIVED.102 <br /> FEB 09 2016WRCB,January 2006 <br /> Spill Bucket Testing Report For ,/ <br /> This form is intended for use by contractors performing annual testing of UST spill conta v d form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operator for sub t e local 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 <br /> hone:Date Local Agency Was Notified of Testing: 12/29/2015 <br /> Name of LocalAgency Inspector(i presentwring testing) <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan iuc..6805 Sierra Court Suite G,Dublin,Ca.94568 Ph.9 925-551-7555 <br /> "Technician Conducting Test: Tim Adams <br /> Credentials:(1) CSI,B 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 Other <br /> Test Equipment Used: Standard"I'ape Measurer Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 87 Vapor 2 91 Vapor 3 4 <br /> Number,Stored Product,etc. <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> X Contained in Sump X Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" <br /> Bucket Depth: 14" 14" <br /> Wait time between applying <br /> Irvin Irvin <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 11-30 11:30 <br /> Initial Reading(Ri): 12" 12" <br /> Test End Time(TO: 12:30 12:30 <br /> Final Reading(Rf) 12" 12" <br /> Test duration(Tf-Ti): I hr l lir <br /> Change in Reading(Rf-Ri): 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Results: X Pass Fail X Pass Fail 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 /> /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 />