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SWRCB, January 2006 <br />9. pill Bucket Testing Repor or <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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: ARCO #02130, CC18022643 DateofTesting: 07/24/2009 <br />Facility Address: 7906 N. EL DORADO @ HAMMER , STOCKTON, CA, 95204 <br />Facility Contact: DEALER/MANAGER <br />Phone: (209) 957-2987 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): GARRETT BACKUS REHS <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: JOEY MESA <br />Credentials i : <br />0 <br />CSLB Contractor <br />E <br />ICC Service Tech. [:I SWRCB Tank Tester El Other (Specify) ICC SERVICE <br />License Number: 52S9458 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: F11 Hydrostatic El Vacuum Other <br />Test Equipment Used: TAPE MEASURE Equipment Resolution: VISUAL LOSS <br />Identify Spill BUcket(By Tank <br />Number, Stored Product, etc) <br />i 1 UNL FILL <br />2 2 REG FILL 3 3 REG FILL <br />4 4 PRE FILL <br />Bucket Installation Type: <br />Direct Bury <br />® Contained in Sump <br />® Direct Bury � Direct Bury <br />® Contained in Sump ® Contained in Sump <br />® Direct Bury <br />® Contained in Sump <br />Bucket Diameter: <br />10 1/411 <br />10 1/411 10 1/411 <br />10 1/411 <br />Bucket Depth: <br />14 1/4" <br />14 1/4" 14 1/4" <br />14 1/4' <br />Wait time between applying <br />vacuum/water and starting test: <br />5 MIN. <br />5 MIN. 5 MIN. <br />5 MIN. <br />Test Start Time (TI ): <br />11:20 <br />11:20 11: 20 <br />11:20 <br />Initial Reading (RI ): <br />14" <br />14" 14" <br />14" <br />Test End Time (TF ): <br />12 : 2 5 <br />12 : 2 5 12 : 2 5 <br />12 : 2 5 <br />Final Reading (RF ): <br />14" <br />14" 14" <br />14" <br />Test Duration: <br />60 MIN. <br />60 MIN. 60 MIN. <br />60 MIN. <br />Change in Reading (R F - RI ): <br />0 " <br />0 " 01, <br />0 " <br />Pass/Fail Threshold or <br />Criteria: <br />VISUAL LOSS <br />VISUAL LOSS VISUAL LOSS <br />VISUAL LOSS <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: <br />07/24/2009 <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 />