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SWRCB,January 20 Page_of SVIRCIl,January 2002 Page—Of— <br /> nmen Repo M <br /> 9 4, TAN?(.1NA.TLART—rST LNG <br /> This form is intended for use by co peormingp 'UST secondary con systems. Use the Test Method—b evelopd By: �5 Tank Manufacturer Industry Standard 0 Professional Engineer <br /> appropriate pages oftbaform to report resullsfor all completedform, stprocedures,and <br /> printoutsfrom tests(f qpplxablz),should beprovided erfiorsubnuuat cal,egulatory ag—y. C Other(Specify) <br /> Test Method Used: _7 Pressure LxVac-jum C Hydrostatic, <br /> 1. FACI OWMA 7-Offier(Specify) <br /> Facility Name:—Wilson way Chevr VMNbj4t,of_T&fnW t.0 7,2-0-Tlf— ntUsed:VaCutim,pump,/gauge Eq <br /> .9520 Test Equipme ; uilgent Resolution5 0 P -1:19 <br /> Fac[lityAddxess:437 Wilson WE,EC,- <br /> 1 Facility Contact:AHman Mehroki 344 <br /> Tank# <br /> Date Local Agency Was Notified oTesting:Sept.25 2 01 4 AdowIs Tank Exempt From Test ng?' D 3 es �No I u Yes �No O Yes O No ❑ <br /> O No <br /> Name of Local Agency Yes <br /> Inspector(,fpresear during testing <br /> Tank Capacity: 11,873 11,873 <br /> 2. TESTING CONTRACTOR INF ®N 1AWTankMateraal FRP FRP <br /> � <br /> Company;R AEW�—Raliabla Petroleum Services Ina Tan}Manuser: Owens Corning Owens Cornin <br /> Technician Conducring Test,!Ernesto Bernabe <br /> Credentials: .3 SLB Licensed Contractor 0 SWRCB"Mnsed Tank —------ <br /> time tweeaapp <br /> License Type: A urelvacuum/water and 10min. 10min. <br /> test <br /> Manufacturer Component(s) in Expires tart'Trut: 9;3 0 air, 9.4 5 am <br /> ICC Sevice Tech A4NW,2 015 -ding(R,): i 0,,H9- 10,Tq,, <br /> INCON TS–STS PAM 2015 Time: 10--- 1 I <br /> Ak g(Rv): 101, <br /> v= Hg 10"Hg <br /> TX Duration: 1hr. --------–-- <br /> Alk 1 1hr. <br /> 3. SUNEYWRY OF TrEST RESULTS change in PC �g 01,H4 <br /> P.`F.H T Criteria: <br /> i Not lRepair, .4 <br /> Component !Pass!Fail Torted <br /> M Component Pass im ria: ±0.0"Hg ±O.O"Hg <br /> Made j -- - - <br /> Test RAW A z Pass :Fail P <br /> 'Annular Space 87 a a. E Fail M Pass C Fail C Pass 0 Fail <br /> as <br /> - <br /> 2NO ❑7–NA <br /> Annular Space 91 17, 1 W oved for tea Ye's MNo --,NTA CYes Zllio --NA Z Yes L No CNA q <br /> SSecondary 87 I I 1: n, 1: <br /> or properlyre 'Yes 5NNo DIN <br /> :Yes O.No Z�,INA OY4os 0,No 01NA CYns ONo ONA <br /> �Secondary 9L---j�gr, D 13 functional <br /> iSTP Sump 87 <br /> z 1 D o D <br /> STP Sump 91 D DiD J I Comments vfo onr afrsmade rortotestin and recommended fbllow or added tests <br /> UDC 1/2 ❑ A, <br /> JUDC 3/4 R. <br /> Ida& <br /> C 5/6 R C: j 0 <br /> UDC 7/8 <br /> UID <br /> ff:L11 Sump 87 <br /> 'Fill Sump 91 <br /> if'hydrostatic,testing was performed,describe what was done with the water after completion of :s: <br /> -dodEVAPP"M <br /> CERTIFICATION OF TECMNICLA–IN RESPONSIBLE FOR CONDUCTING THIS TESTLNG <br /> To.4he best of my knowledge,Imh t stated i ' document am accurate and in full compliance with legal requirements <br /> -te.chnician's Signature; Date: October 7, 1 Adak <br /> y conta nment systems where fhe cont mous monitor n catty monitors So and secondary <br /> errt,such as systems that are hydrostatically monitored or nstant vacuum., from periodic containment <br /> '"' testing. {Califemia Code of Regulations,Title 23,Section 2637( <br /> OCT 3 2014 <br /> 1RONMENTAL <br /> ENV <br /> 441=WTU <br />