Laserfiche WebLink
GFrryjr-RYAN INC. GR Job# 1820- 1728 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <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 (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> f <br /> ilityName: Arco 5450 Date of Testing: 7/19/2018 <br /> ilityAddress: 1617 W. Fremont Stockton 95203ilityContact: Dar 1 Lee Phone Local Agency Was Notified of Testing: <br /> rae of Local ARency Inspector i present during testing): r, <br /> 2.TESTING CONTRACTOR INFORMATION <br /> IaAs <br /> Company Name: Gettler-Ryan Inc.,6805 Sierra Court,Suite G,Dublin,Ca.94568 Ph.#925-551-7555 <br /> Technician Conducting Test: David Rouse <br /> Credentials:(1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number: 220793 ICC Tech Number: <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method U= acuum Other <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1/16" <br /> Identify pt Bucket y Tank 1 2 3 4 <br /> Number,Stored Product,etc. $7-Vapor 87-Vapor 91-Vapor <br /> Bucket Installation Type: irect �' u+ect Bury uect Bury uect ury <br /> ontained in Sump XQContained in Sump QX Contained in Sump []Contained in Sump <br /> Bucket Diameter: 1211 1219 1211 <br /> Bucket Depth: 1411 1411 1411 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> 5 mins 5 mins 5 mins <br /> Test Start Time(Ti): 10:50 10:50 10:50 <br /> Initial Reading(Ri): 12 1/2 12 1/2 12 112 <br /> Test End Time(Tf): 11:50 11:50 11:50 <br /> Final Reading(Rt) 12 1/2 12 1/2 12 112 <br /> Test duration(Tf-Ti): 1 hr 1 hr 1 hr <br /> Change in Reading(Rf-Ri): 0 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> est call ts: pass ail ITail EPass, ail Pass ail <br /> Comments- include information on repairs made prior to testing-and recommended ollow- orailed tests <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that aU the information contained in this r rt is true,accurate,and in full compliance with legal requirements <br /> Technician's Signature: Date: 7/19/2018 <br /> (1) 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 />