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RECEIVED <br /> ®6ErraR-RYAN INC. GR Job# 1820- 1789 <br /> JUL 13 2013 <br /> SWRCB,January 2006 <br /> Spill Bucket Te!� 2� V-C4nr'T <br /> This form is intended for use by contractors performing annuaHEAWki�i ptl��c�ah7ainmenl structures. The Completed form and <br /> printouts from tests (if applicable), should be provided to the facility ownerioperator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name: Arco 7149 Date of Testing: 06/20/2018 <br /> Facility Address: 9484 West Late Stockton 95210 <br /> Facility Contact: Dar 1 Lee Phone: 415-902-5089 <br /> Date Local Agency Was Notified of Testing: <br /> Lame o ca gency Inspector i present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <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 Used: hydrostatic Vacuum Other <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number,Stored Product,etc. 87-vapor 91-.vapoX <br /> irect Bury rTirect Bury irect Bury irect Bury <br /> Bucket Installation Type: <br /> ontained in Sump QX contained in Sump E]Contained in Sump F]Contained in Sump <br /> Bucket Diameter: 1411 14" <br /> Bucket Depth: 1511 15 <br /> Wait time between applying <br /> 11 0 <br /> WTd- <br /> vacuum/water and start of test: 5 mins 5 mins <br /> Test Start Time(Ti): 10 :30 10 :30 <br /> Initial Reading(Ri): 1411 14" <br /> Test End Time(TO: r <br /> 11:30 <br /> Final Reading(RJ) 1411 1411 <br /> Test duration(Tf-Ti): lhr lhr <br /> Change in Reading(Rf-Ri): 01 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Results: I QPRss a2il I QPass QE2il Passail Pass OFail <br /> Comments- include information on repairs made prior to testing,and recommendedfollow-up or failed tests <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this r ort is true,accurate,and in full compliance with legal requirements <br /> Technician's Signature: Date: 06/20/2018 <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 />