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B January 2006 <br /> 0 SWRC ,J ary <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 /> Facility Name: ARCO AM PM#82602 Date of Testing: 10-09-08 <br /> Facility Address: 2430 Joe Pombo Parkway <br /> Facility Contact: Ranjeet Singh Phone: (209)579-4014 <br /> Date Local Agency Was Notified of Testing: 09-09-08 <br /> Name of Local Agency Inspector(fpresent during testing): Michelle Henry <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: RELIABLE PETROLEUM SERVICES INC. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 883706 5250451-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> Identify Spill Bucket(By Tank Tl:87 Master TI:87 Master T2: 87 Slave Fill T3: 91 Fill <br /> Number,Stored Product, etc.) East Fill West Fill <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> X Contained in Sump X Contained in Sump X Contained in Sump X Contained in Sum <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 17' 16'!4" 16'/" 17" <br /> Wait time between applying <br /> vacuum/water and start of test: 1 min. 1 min. 1 min. 1 min. <br /> Test Start Time(TI): 1:02p.m 1:03p.m 1:06p.m 2:17p.m <br /> Initial Reading(RI): 13" 13 7/16" 13%2" 13 5/8" <br /> Test End Time(TF): 2:07p.m 2:08p.m 2:09p.m 3:19p.m <br /> Final Reading(RF): 13" 13 7/16" 13%" 13 5/8" <br /> Test Duration(TF—TI): l hr.5min, lhr.5min. l hr.3min. l hr.2min. <br /> Change in Reading(RF—RI): 0 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> T3: 91 Fill bucket failed due to top seal can, Replaced top seal cap, performed test <br /> Procedure, 91 Fill bucket 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:... - - ' ��� ,F" Date: 10-09-08 <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 />