Laserfiche WebLink
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 fr•orn 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: Frontier Manteca Date of Testing: 9- 13 -2018 L, <br /> Facility Address: 430 West Center St <br /> Facility Contact: Atinesh Chandra Phone: 209-456-9727 <br /> Date Local Agency Was Notified of Testing : 9-5 - 18 <br /> Name of Local Agency inspector (if present during testing) : None Present <br /> 2 . TESTING CONTRACTOR INFORMATION <br /> Company Name: CALIFORNIA HAZARDOUS, INC . <br /> Technician Conducting Test : Raul Ochoa <br /> Credentials ' : ® CSLB Contractor ® ICC Service Tech . ❑ SWRCB Tank Tester ❑ Other (Specify) <br /> License Number(s): 734854 ICC# : 8029372 <br /> 3 . SPILL BUCKET TESTING INFORMATION <br /> Test Method Used : ® Hydrostatic ❑ Vacuum ❑ Other Visual (Spec) _ ___ <br /> Test Equipment Used : Measuring Tape Equipment Resolution : 1116 " <br /> Identify Spill Bucket (fay Tank Tl Diesel <br /> Number, Stored Product, etc) <br /> ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> Bucket Installation Type : ® Contained in Sump ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump <br /> ❑ On Top of AST ❑ On Top of AST ❑ On Top of AST ❑ On Top of AST <br /> Bucket Diameter: 12" <br /> Bucket Depth : 14 .75 " <br /> Wait time between applying 15 Min <br /> vacuum/water and start of test : <br /> Test Start Time (Ti): 11 :45am <br /> Initial Reading (Rr) : 13 .25 " <br /> Test End Time (TF) : 12 :45pm <br /> Final Reading (RF) : 13 . 25 " <br /> Test Duration (TF . Tz) : 1 Hour <br /> Change in Reading ( RF - Rj) : 0 <br /> Pass/Fail Threshold or Criteria: Any Visible Drop <br /> I ' <br /> Test Result: Pass ❑ Fail F1Pass ElFail ElPass ElFail ❑ Pass ❑ Fall <br /> r <br /> Comments (include information on repairs made prior to testing and r•eaorrunended follow-zzp for failed tests) <br /> Water was placed inside 5 gallon bucket and left on site for proper disposal . <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereky certify that all the in ration ontained in V itissrreport is true, accurate, and in full compliance with legal requirements. <br /> Technician ' s Signature: " �' Date 9- 13 -2018 <br /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be <br /> more stringent. <br /> I <br />