HomeMy WebLinkAboutSB GAS 20151. FACILITYINFORMATION
Facilitv Name: ROSEDALE PLAZA GROUP Date of Testing: 2-19-15
Facility Address:785I ROSEDALE HWY
Facility Contacr NOLLIE Phone: 661-588-0557
Date Local Agency Was Notified of Testing:2-t3-t5
Name of Local Agency Inspector (if present during testing): SHANE GARDNER
SWRCB, January2006
Spitl Bucket Testing Report Form
Thisforn is intendedfor use by contractors performing annual testing of UST spill containment structures. The completedform and
printoutsfrom tests (if applicable), should be provided to thefacility owner/operatorfor subnittal to the local regulatory agency.
2. TESTING CONTRACTOR INFORMATION
3. SPILL BUCKET TESTING II\TFORMATION
CERTTT'ICATION OF TECHNICIAN RESPONSIBLE tr'OR CONDUCTING TTIIS TESTING
I hercby cerlily that all the information contained in this rqort is tflie, aceutole, and in full conryliance with legal requiremen&.
&-rg- t5
I State laws and regulations do not currently
may be more stringent.
CompanyName:BSSRINC,
Technician Conducting Test:SALVADOR SANCHEZ
Credentialsr: Xtr CSLB Contractor X tr ICC Service Tech. n SWRCB Tank Tester tr Other (Spectfy)
LicenseNumbeds): CSLB#672812 / ICC TECH#5309490-UT
Test Method Used: X[ Hydrostatic I Vacuum ! Other
Test Equipment Used: VISUAL Equipment Resolution:
Identi& Spill Bucket (fu Tank
Number, Stored Product, etc.)
1 T1.T]hILEADEI)
SPILBUCKET 1
2 TI.UI{LEADED
SPIL BUCKET 2
3 T3-PREMIT'M 4T2-UNLEADED
Bucket Installation Type:
tr Direct Bury
Xtr Contained in
Sumn
tr Direct Bury
Xtr Contained in
Sumo
tr Direct Bury
XE Contained in
Sumo
tr DirectBury
Xtr Contained in
Sumo
Bucket Diameter:t2"t2"12"t2"
Bucket Depth:16"16"17"16"
Wait time between applying
vacuum./water and start of test:15 MIN.15 MIN,15 MIN,I5 MIN,
Test Start Time (Tr):9:00 AM 9:00 AM 9:00 AM 9:00 AM
Initial Reading (ft):l0 Yl"10"9 Y4"10"
Test End Time (Tp):t0:00 AM t0:00AM 10:00AM 10:00 AM
Final Reading (Ra):l0 tA"10"9 Yo"10"
Test Duration (Tr - TJ:1 HOUR I HOUR 1 HOUR I HOUR
Change in Reading (R.r-RJ:0 0 0 0
Pass/Fail Threshold or
Criteria:0.0002"0.0002"0.0002"0.0002"
.,TestRcffilt::,,,X{}: :PlBg;,,.., E tr'gi[,.,-,,Xil.ks* flFoil,,,
Comments - (include information on repairs made prior to testing, und recommended follow-up for failed tests)
ire testing to be performed by a qualified contractor. However, local requirements