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9255517899 Line 1 00 -42 a.m. 04-01-2011 6/7 <br /> ®GETTLER-RYAN INC. GR Job # 10-058090 <br /> 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 6080 Date of Testing: 3/14/2011 <br /> Facility Address: 85 E Louise Ave <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(i present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc.,6747 Sierra Court Suite J,Dublin,Ca.94568 Ph.#925-551-7555 <br /> Technician Conducting Test: Chris Bishop <br /> Credentials:(1) CSLB Contractor [CC service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number: 220793 ICC Tech Number: 8057545-UT <br /> 3.SPILL BUCKET TESTING INFO%MATION <br /> Test Method Used: Hydrostatic Vacuum Other <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1/16" <br /> Identify Spill Bucket(Bv Tank 1 87 Vapor 2 87-2 Vapor 3 91 Vapor 4 <br /> Mu mber,Stored Product,etc) <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> Contained inSumu Contained inSuma Contained in Sump lContained in Sump <br /> Bucket Diameter: 12 12 12 <br /> Bucket Depth: 15 15 15114 <br /> Wait time between applying <br /> Smin Smin Smin <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 1:55 1:55 3:35 <br /> Initial Reading(Ri): 8.75 !0 11 .75 <br /> Test End Time(Tt): 2:55 2:55 5:45 <br /> Final Reading(Rf) 8.25 10 11.75 <br /> Test duration(Tf-Ti): lhr thr 1hr <br /> Change in Reading(Rf-Ri): 0 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 <br /> Test Results: PasFail Pas Fail Igas Fail [PassI Fair <br /> Comments-(include information on repairs made prior to testing, and recommended folloiv-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: 3/14/2011 <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 />