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9. Spill Bucket Testing Report Form SWRCB,January 2006 <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(f applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> FacilityName: ARCO #06080, CC 18022649 r Date of Testing: 09/17/2008 <br /> Facility Address: 85 E LOUISE AVE PTO N-71, LATHROP, CA, 95330 <br /> Facility Contact: MANGER Phone: (2 0 9) 983-9144 <br /> Date Local Agency Was Notified of Testing: 08/11/2008 <br /> Name of Local Agency Inspector(if present during testing): MICHELLE HENRY <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: DENNIS RUE <br /> Credentials 1: ❑CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester Z Other(Spec) ICC <br /> License Number: 5246067-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: 1fl Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: TAPE MEASURE Equipment Resolution:VISUAL <br /> Identify Spill Bucket(By Tank 1 1 REG FILL 2 2 PLU FILL 3 3 PRE FILL 4 <br /> Number, Stored Product, etc) <br /> Bucket Installation Type: 1:1Direct Bury E]Direct Bury ❑Direct Bury E]Direct Bury <br /> ❑X Contained in SumpX❑Contained in Sump ❑X Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 12 12 12 <br /> Bucket Depth: 14.50 14 13.50 <br /> Wait time between applying 5 5 5 <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 0900 0900 0900 <br /> Initial Reading(RI ): 13 13 13 <br /> Test End Time(TF): 1000 1000 1000 <br /> Final Reading(RF ): 13 13 13 <br /> Test Duration: 60 MINS. 60 MINS. 60 MINS. <br /> Change in Reading(R F-RI ): 0 0 0 <br /> Pass/Fail Threshold or P P P <br /> Criteria: <br /> Test Result a;Pass Fail "'- a ass. Fall <br /> rI ` X; Pass Fail = Q'Pass°❑ ail <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 requirements. <br /> Technician's Signature: e--/"e—, A Date: 09/17/2008 <br /> I 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 />