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Work Order": 2249432 <br /> SWRCB,January 2406 <br /> Spill Bucket Testing Report Form <br /> This farm a irdmded for use of UST-YpiU=dannmt sftctures.ne completedform and <br /> printmaftom tests(rf gpglieable),shoartd be provided to nonfacility owns/operatorfor submittal to the local reguiat&J'agmey <br /> 1. FAClZ.IW INFORMATION <br /> Facility Name: r hate of Testing: 37-51-07 <br /> Facility Address: I S 0 <br /> Facility Contact phone: <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency lnspecW(rfpreser t during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: <br /> Technician Conducting Test: <br /> Credentials': €B Contractor 01CC Service Teck 0 SWRCB Tank Tesus 0 Other(Sp€c& <br /> License Numbafs): <br /> 3. SPILLBUCXET TESTING INFORMATION <br /> Tont Method Used: 0 Hydrostatic ❑Vacuum 0 Outer <br /> Test Equipinwt Used: (�/ t Equipment KMI)ttion- <br /> lde city Spill Bucket(By Tank 1 J Cr 2 ar 3 � d 7 <br /> Nwnber.Stored Prarfarct etG <br /> Bucket Installation Type: trent Bury 16biva Bury Z Direct Bury vvirectBury <br /> 0 Contained in Suet 0 Co nu ined m Sum 0 Contained in Sump 0 Contained in Sum <br /> Bueke4 Diameter': rL,. <br /> Budd Depth: t <br /> Wait time between applying <br /> vacuum/water and start of test <br /> Test Start Time(171) <br /> Initial R,eadkg(&): <br /> Test l nd Time(TF>: r <br /> Final Reading(Pw): J <br /> Ted Duration To- <br /> Mange <br /> in Reading(RF-R4' <br /> PasslFA Tbmbo)d or <br /> Criteria: 1/t w rt <br /> Te aM' Paas 0 Fain Paas •. top .iP88s V to Paas O FAil <br /> CottLm entS—(aelade Wortmartion on ME Ys made EELw to testing and rwom ottow for fatted rests <br /> CERTIFICATION OF TECHNICIAN RESPONSIRL19 FOR CONDUCTING THIS TESTING <br /> I kereby cert fy&M all at' canrabred Lr lifts report Is tare,armnwA and fro,f W C0fWAmce tr&*!eget regi' <br /> Technician's Signature; Date: 5 <br /> 'Sm laws and reguletions do not currently requite tm*g to be by a qualified cont<acbor.ii+e+tivever,local requirements <br /> may be mom Stringent. <br /> Tanknology Inc. 8501 N.MoPac Expressway,Suite 400,Austin,Texas 78759 <br />