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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> Phis form is intended for use by contractors performing al testing of UST spill containment es The completed form and <br /> print from tests(if applicable),should be provi&d to the facility ownerloperatorfor submittal to the local regulatory agency. <br /> 1. FAC HJTY EffORMATION <br /> Facility Name: Arco I Date of Testing: 10/1912010 <br /> Facility Address: 2430 Joe Pombo Parkway --J-Phone: 209-579-4014 <br /> Facility Contact Rartiect Singh <br /> Date Lxxmi Agency Was Notified of Testing October 54,1010 <br /> Name of Local Agency hispector(#present during testing): Stacey Rivera <br /> 2. TESTING CONTRACTOR WORMATION <br /> Company Name: Reliable Petroleum Services,Inc. <br /> Technician Conducting Test. Guadalupe Sanchez <br /> Credentials': X CSLB Contractor X ICC ce Tech. 0 SWRCB Tank Tester 0 Other(Sqecify) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic 11 Vacuum 0 Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: N/A <br /> Identify Spill Bucket(By Tank T-187 West Fill T-187 East Fill T-3 91 Fill Bucket 4 T-2 87 Syphon Fill <br /> Number,Stored Pr ,eta Bucket Bucket Bucket Lh , Direct Bury Direct Bury Direct Bury 0 Direct Bury <br /> Bucket Installation Type: X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sump <br /> Bucket Diameter. 12" 12" IT, IT, <br /> Bucket Depth- 16 3/8" 17 3/4" 16 3/4" 16 V2" <br /> Wait time between applying I min. I min. I min. I min. <br /> -vacuum/water and start of test. <br /> Test Start Time(TO: 1:31 pin 1:32 pin 1:33 pin 12:08 pm <br /> Initial Reading(R.1): 14 1/4" 15 1/8" 16" 15 1/8" <br /> Test End Time(TF): 2:31 pin 2:32 pin 2:33 pin 1:08 pin <br /> -Final Reading(RF): 14 1/4" 15 I/r 16" 15 1/8" <br /> Test Duration(TF-TO: I Hour I Hour I Hour I Hour <br /> Change in Reading(RF-R1): 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: X pass o Fan X Pass 0 Fail X Fars 3 Fail <br /> C —(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Replaced Fill Cans on 87 and 91 tanks, Retested and passed. <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: -.-- - -- 1 Date:__October 19'h 2010 <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 />