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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 ownerloperatorfor submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO AM PM#82602 1 Date of Testing: 10-21-09 <br /> Facility Address: 2430 Joe Pombo Parkway,Tracy CA 95377 <br /> Facility Contact: Ranjeet Singh I Phone: 209-579-4014 <br /> Date Local Agency Was Notified of Testing: 10-06-09 <br /> [_Name of Local Agency inspector(it(present during testing): Michelle Henry <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Reliable Petroleum Services Inc. <br /> Technician Conducting Test: Robert Barnhart <br /> Credentials': X CSLB Contractor X ICC Service Tech. 0 SVvrRCB Tank Tester 0 Other(Specify) <br /> i-License Number(s): 883706 5252540-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic 0 0 Other <br /> Test Equipment Used:Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tan T1:Master Fill East 71: Master Fill West T2: Slave Fill T3:91 Fill <br /> Number,Stored Product, etc.2 <br /> Bucket Installation Type: 0 Direct Bury 0 Direct Bury 0 Direct Bury 0 Direct Bury <br /> . X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum2 <br /> Bucket Diameter: 1299 12" 12" 12" <br /> Bucket Depth: 17 Y21 17" 16 Y299 17" <br /> Wait time between�—applying <br /> vacuum/water and start of test: 2min. 2min. 2min. 2min. <br /> Test Start Time(TI): 1:34p.m 1:34p.m 1:35p.m 1:35p.m <br /> Initial Reading(Rj): 13%" 13%" 1:35p.m 1:35p.m <br /> Test End Time(TF): 2:39p.m 2:39p.m 2:40p.m 2:40p.m <br /> Final Reading(RF): 13%" 133/491 13 Y499 1359 <br /> Test Duration(TF—T): 1hr.5min. 1hr.5min, 1hr.5min. 1hr.5min. <br /> Change in Reading(RF-RI): 0 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: 1/16" 1/1611 1/1611 1/16" <br /> [Test Result: X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail X Pass 0 Fail <br /> Comments—(include information on repairs made prior to testing 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: M <br /> ('�-L&fc3aArl Date: 10-21-09 <br /> C Y-Nt <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 />