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SWRCB, January 2002 Page of <br />a Curr n«n1WTT r <br />T n1'VTAYN1WF.N'r ROW' <br />Commeni5 (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />Please direct any comments regarding this form to: <br />SWRC13 UST Program, Attn: Scott Bacon <br />1001 "1" Street, Box 944212 <br />Sacramento, CA 95814 <br />Phone: (916) 34.1-5873, Fax: (916) 341-5808 <br />e-mail: bacons@cwp.swrcb.ca.gov <br />7. 01 a e .y'a, v ♦ <br />Facility is Not Equipped With SpilUOverfill Containment Boxes ❑ <br />Spill/Overfill Containment Boxes are Present, but were Not Tested ❑ <br />Test Method Developed By: <br />❑ Spill Bucket ManufacturerIndustry Standard ❑ Professional Engineer <br />❑ Other (Specify) <br />Test Method Used: <br />❑ Pressure ❑ Vacuum <br />Hydrostatic <br />❑ Other (Specify) <br />Test Equipment Used: <br />Equipment Resolution <br />Spill Box # l Spill Box # <br />® Spill Box # Spill Box # <br />Bucket Diameter: <br />I l l f <br />11 <br />Bucket Depth: <br />! 1 <br />Wait time between applying <br />_ <br />pressure/vacuum/water and <br />-^""— - <br />starting test: <br />Test Start Time: - <br />/coo v U <br />Initial Reading (111): <br />-7 <br />3 <br />Test End Time: <br />Final Reading (RF): <br />® <br />7 �- <br />3 <br />Test Duration: <br />1 <br />Change in Reading (RF -R,): <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: <br />Pass ❑ FailPass ❑ Fail <br />Pass ❑ Fail ❑ Pass ❑Fail <br />Commeni5 (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />Please direct any comments regarding this form to: <br />SWRC13 UST Program, Attn: Scott Bacon <br />1001 "1" Street, Box 944212 <br />Sacramento, CA 95814 <br />Phone: (916) 34.1-5873, Fax: (916) 341-5808 <br />e-mail: bacons@cwp.swrcb.ca.gov <br />