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I , S254617888 Line 1 <br />GETTIER-RYAN INc. <br />ANIL <br />0:13:00 06-25-2012 2/2 <br />4 <br />GR Job # 20-580972 <br />SWRCB, January 2006 <br />Spall 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 2093 Date of Testing: 6/8/2012 <br />Facility Address: 3425 Tracy Blvd., Tracy, CA <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing: 6/1/2012 <br />Name of LocMAgency 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: <br />Credentials: (1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other (Specify) <br />License Number: 220793 ICC Tech Number: <br />3. SPILL BUCKET TESTING INFORMATION <br />Tel Method Used: <br />hydrostatic <br />Vacuum <br />Other <br />Test Equipment Used: <br />Standard Tape Measurer <br />Equipment Resolution: <br />1/16" <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 87 <br />Octane 2 <br />2 91 <br />Octane <br />3 4 <br />Bucket Installation Type: <br />Direct Bury <br />K Contained in Sump <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Bucket Diameter: <br />I 1 <br />11 <br />Bucket Depth: <br />13 <br />13 <br />Wait time between applying <br />vacuum/water and start of test: <br />15 min. <br />15 nein. <br />Test Start Time (Ti): <br />9:30 <br />9:30 <br />Initial Reading (Ri): <br />121/8 <br />12 118 <br />Test End Time (TO: <br />10:30 <br />10:30 <br />Final Reading (111) <br />121/8 <br />121/8 <br />Test duration (Tf - Ti): <br />1 hr. <br />1 hr. <br />Change in Reading (Rf-Ri): <br />0 <br />0 <br />PazTail Threshold or Criteria: <br />0 <br />0 <br />0 <br />0 <br />Test isesults' <br />Nit. - <br />... PA95 FaHI.: <br />Pass.. Fail <br />Pass.. Fail. <br />Comments- (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby cer7J& that all the information contained In this report is true, accurate, and in full compliance with legal requirements <br />Technician's Signature: Mike Pratt Date: 6/8/2012 <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 />