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ig6ETTaR-RYAN INC GR Job# 20-640102 <br /> SWRCB.January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of (.ST 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 /> FacilityName: Arco 60 Date o -estmg: 2/272016 ft S� V' _ <br /> Facility Address: 85 E Louise Ave-,Lathrop <br /> Facility Contact: Phone: ib <br /> Date Local Agency Was Notified of Testing: 12/29/2015 <br /> ame o Localgen y i spec o i pre, uring es rng . - j <br /> ghlvi <br /> i.tC.Cllrt<t t�C17C4?T"firAtT <br /> NTAL <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gett er-Ryan Inc..6805,Sierra CourtSuite G, )ublin,Cit. 56 Ph,#9 5-551-75;5 <br /> Technician Conduct[I-ing Test: Tim Adams <br /> Credentials:(1) CSLB Contractor ICC service Tech. S W1tC13 Tank Tester Other(Specify) <br /> License um er: 220793 1 C Tec Num Number- 0.0 <br /> 30 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> est Metro Use IlFdrostatic vacuum Other <br /> Test Equipment Used: Standard Tape I1leat,urer Equipment Resolution: 1/16" <br /> Identify Spill Bucket(fav Kmk 1 87 Fill 2 91 Fill 3 Diesel Fill q <br /> Number, S7ored Produce,etc. <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury WD, <br /> \ Contained in Sump \ Contained in Sump \ Contained in Sump <br /> rB.cket <br /> cket Diameter: 12" l�" 12" <br /> Depth: ly1, 14„ 1;„ <br /> it time between applying <br /> uut-Wwater and start of test: I mmImin 1min <br /> t Stan Time(Ti): 10:00 10:00 10:00 <br /> Initial Reading(Ri): 13 13.5" 13" <br /> Test End Time(TO: 11:00 11:00 11:00 <br /> Fina)Reading(Rf) 13" 13.5" 13^ <br /> Test duration(Tf-Ti): 1 hr I hr 1 fir <br /> Change in Reading(Rf-Ri): 0 0 0 <br /> PassiFail Threshold or Criteria: 0 0 (1 X PASS Fail Y Pass Fail r Pass Fail <br /> Comments-(include information on repairs made prior to testing,and recommendedfolloir-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: 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 />