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' <br /> 9. Mill Bucket Testing eror or 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 /> FacilityName: ARCO # 02093 CC18022760 DateofTesting: 12/29/2009 <br /> Facility Address: 3425 TRACY BLVD , TRACY, CA, 95376 <br /> Facility Contact: MANAGER Phone: (2 0 9) 835-1605 <br /> Date Local Agency Was Notified of Testing: 11/24/2009 <br /> Name of Local Agency Inspector(if present during testing): MICHELLE HENRY RENS <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: JOEY MESA <br /> Credentials 1: E CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester Other(Sped) I CC SERV I CE <br /> License Number: 5259458-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: El Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: TAPE MEASURE Equipment Resolution:1/8" <br /> Identify Spill BUcket(By Tank 1 1 UNL FILL 2 2 UNL FILL 3 3 UNL FILL 4 4 PRE FILL <br /> Number, Stored Product, etc.) <br /> Bucket Installation Type: Direct Bury Direct Bury F-1Direct Bury Direct Bury <br /> XQ Contained in Sump Contained in Sump QX Contained in Sump ❑X Contained in Sump <br /> Bucket Diameter: 1211 1211 1211 1211 <br /> Bucket Depth: 1311 1311 1311 1311 <br /> Wait time between applying 5 MIN. 5 MIN. 5 MIN. 5 MIN. <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 10:4 7 10:4 7 10:4 7 10:4 7 <br /> Initial Reading(R I ): 12 1/211 12 1/211 12" 1211 <br /> Test End Time(TF): 11:52 11:52 11:52 11:52 <br /> Final Reading(R F ): 12 1/2" 12 1/2" 12" 12" <br /> Test Duration: 60 MIN. 60 MIN. 60 MIN. 60 MIN. <br /> Change in Reading(R F-RI ): 0" Off 01' 0" <br /> Pass/Fail Threshold or PASS PASS PASS PASS <br /> Criteria: <br /> Test Restdit: Pass, Fain. ❑Pass' Fail [XjPass,[:] FailQ Pass � 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: _ 1" � Date: 12/29/2009 <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 />