Laserfiche WebLink
SWRCB,January 2006 <br /> . Stal Bucket Testing Repo 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 /> FacilityName: CHEVRON # 96171 Date of Testing: 01/15/2010 <br /> Facility Address: 6633 PACIFIC AVE , STOCKTON, CA, 95207 <br /> Facility Contact: MGR - SUE LYNN Phone: (2 0 9) 4 7 7-4 2 94 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing): garrett <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: STEVEN WILLEMS <br /> Credentials 1: CSLB Contractor EICC Service Tech. SWRCB Tank Tester o Other(Spec) icc <br /> License Number: 8 016 9 7 4 u <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: a Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: tape measure Equipment Resolution:1/8 inch <br /> Identify Spill Bucket(By Tank 1 1 SUP FILL 2 2 UNL FILL 3 3 UNL FILL 4 <br /> Number, Stored Product, etc.) <br /> ❑Direct Bury ❑Direct Bury ❑Direct Bury F-1DirectBury <br /> Bucket Installation Type: Q Contained in Sump X❑Contained in SumpX❑Contained in Sump ❑ Contained in Sump <br /> Bucket Diameter: 12 12 12 <br /> Bucket Depth: 13.75 13.75 13.75 <br /> Wait time between applying 5 mins 5 mins 5 mins <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 940 940 940 <br /> Initial Reading(RI ): 12.75 12.75 12.75 <br /> Test End Time(TF ): 1040 1040 1040 <br /> Final Reading(R F ): 12.75 12.75 12.75 <br /> Test Duration. 1 hour 1 hour 1 hour <br /> Change in Reading(R F-RI ): 0 0 0 <br /> Pass/Fail Threshold or visual visual visual <br /> Criteria: <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: 01/15/2010 <br /> I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />