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UETTlER-RYAN INC. RECEMIEEY <br /> 820- 1786 <br /> AUG 1 6 2018 SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill c t [��s. The Completed form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operatHoEA �+ -4I 4fal regulatory agency. <br /> 1.FACILITY INFORMATION r" <br /> Facility Name: Arco 7148 Date of Testing: 06/19/18 <br /> Facility Address: 3400 N. MacArthur Tracy 95376 <br /> Facility Contact: Daryl Lee Phone: 415-902-5089 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency 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:dZUZbJU <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(lay"Tank I 2 3 4 <br /> Number,Stored Product,etc. 91-vapor 87-vapor <br /> Bucket Installation Type: LjDirect Bury LjDirect Bury LjDirect Bury LjDirect Bury <br /> QX Contained in Sump ❑X Contained in Sump QContained in Sump ❑Contained in Sump <br /> Bucket Diameter: 101, 1011 <br /> Bucket Depth: 10 1/2 10 1/2 <br /> Wait time between applying <br /> 5 mins 5 mins <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 10 : 15 10 : 15 <br /> Initial Reading(Ri): 911 911 <br /> Test End Time(Tf): 11 : 15 11 : 15 <br /> Final Reading(Rf) 911 911 <br /> Test duration(Tf-Ti): 1 hr 1 hr <br /> Change in Reading(Rf-Ri): 0 0 <br /> Pass/Fail Threshold or Criteria: 11 0 11 U <br /> Test Results: L_2Pass ❑Fail [DPass ❑Fail 0Pass ❑Pail ❑Pass ❑Fail <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 t 's report is true,accurate,and in full compliance with legal requirements <br /> Technician's Signature: 4e= Date: 06/19/2018 <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 />