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SWRCB, January 2006 <br />9. AP,1 Bucket Testing Report 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 />FacilityName: ARCO #05450, CC 18022647 <br />DateofTesting: 09/24/2009 <br />Facility Address: 1617 W. FREMONT , STOCKTON, CA, 95205 <br />Facility Contact: DEALER/MANAGER <br />Phone: (209) 462-1617 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY , INC. <br />Technician Conducting Test: JOEY MESA <br />Credentials 1: ❑ <br />CSLB Contractor <br />E <br />ICC Service Tech. E] SWRCB Tank Tester <br />E <br />Other (Spec) ICC SERVICE <br />License Number: 5259458 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />El Hydrostatic 1:1 Vacuum <br />❑ Other <br />Test Equipment Used: TAPE MEASURE <br />Equipment Resolution: VISUAL LOSS <br />MM FEN— <br />Identify Spill Bucket(By Tank <br />Number, Stored Product, etc) <br />1 1 REG FILL 2 2 REG FILL <br />3 3 PRE FILL 4 <br />Bucket Installation Type: <br />® Direct Bury ® Direct Bury <br />❑X Contained in Sump[Z] Contained in Sump <br />®Direct Bury ® Direct Bury <br />® Contained in Sump ❑ Contained in Sump <br />Bucket Diameter: <br />1311 1301 <br />1311 <br />Bucket Depth: <br />1401 1411 <br />1411 <br />Wait time between applying <br />vacuum/water and starting test: <br />5 MIN. 5 MIN. <br />5 MIN. <br />Test Start Time (TI ): <br />11:10 11:10 <br />11: 10 <br />Initial Reading (RI ): <br />13 1/4" 13 1/8" <br />13 1/2" <br />Test End Time (TF ): <br />12:15 12:15 <br />12: 15 <br />Final Reading (RF ): <br />13 1/4" 13 1/8" <br />13 1/2" <br />Test Duration: <br />60 MIN. 60 MIN. <br />60 MIN. <br />Change in Reading (R F - RI ): <br />0 " Off <br />01, <br />Pass/Fail Threshold or <br />Criteria: <br />VISAUAL LOSS VISUAL LOSS <br />VISUAL LOSS <br />� <br />Tees , F s i <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 informationcontainedin this report is true, accurate, and in full compliance with legal requirements. <br />Technician's Signature: Date: 09/24/2009 <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 />