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E6 <br />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 (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 # 02093 CC18022760 Date of Testing: 11/26/2008 <br />Facility Address: 3425 TRACY BLVD TRACY, CA, 95376 <br />Facility Contact: MANAGER <br />Phone: (209) 835-1605 <br />Date Local Agency Was Notified of Testing <br />Name of Local Agency Inspector (if present during testing): MICHELLE HENRY <br />2. TESTING CONTRACTOR 1' 1 <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: DENNIS RUE <br />Credentials I : ❑ <br />CSLB Contractor <br />E <br />ICC Service Tech. 11 SWRCB Tank Tester <br />o <br />Other (Specify) I CC <br />License Number: 5246067 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: X❑ Hydrostatic El Vacuum El Other <br />Test Equipment Used: TAPE MEASURE <br />Equipment Resolution: VISUAL <br />Identify Spill BUcket(By Tank <br />Number, Stored Product, etc.) <br />i 1 PRE FILL <br />2 2 REG FILL <br />3 3 REG FILL <br />4 4 REG FILL <br />Bucket Installation Type: <br />Direct Bury <br />Contained in SumpXQ <br />Direct Bury <br />Contained in SumpX❑ <br />Direct Bury <br />Contained in Sump <br />F-1DirectBury <br />QX Contained in Sump <br />Bucket Diameter: <br />12 <br />12 <br />12 <br />12 <br />Bucket Depth: <br />10 <br />10 <br />10 <br />10 <br />Wait time between applying <br />vacuum/water and starting test: <br />5 <br />5 <br />5 <br />5 <br />Test Start Time (TI ): <br />0900 <br />0900 <br />0900 <br />0900 <br />Initial Reading (RI ): <br />9.50 <br />9.50 <br />9 <br />9 <br />Test End Time (TF ): <br />1000 <br />1000 <br />1000 <br />1000 <br />Final Reading (RF ): <br />9.50 <br />9.50 <br />9 <br />9 <br />Test Duration: <br />60 MINS. <br />60 MINS. <br />60 MINS. <br />60 MINS. <br />Change in Reading (R F - RI ): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />P <br />P <br />P <br />P <br />Test Result: <br />1fl Pass Fail <br />XPass ❑Fait <br />a Pass ❑ Fail <br />Pass 1:1 Fail <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: Date: 11/26/2008 <br />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 />