HomeMy WebLinkAbout2017 MOD SPILL BUCKET SWRCB, January 2006
Spill Bucket Testing Report Form
This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and
printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Chevron Date of Testing: 5/3/2017
Facility Address: 1125 Coffee Rd. Bakersfield, Ca.
Facility Contact: Phone:
Date Local Agency Was Notified of Testing :
Name of Local Agency Inspector (if present during testing):
2. TESTING CONTRACTOR INFORMATION
Company Name: Advanced Compliance
Technician Conducting Test: Bradley W. Hinsley
Credentials1: X CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) __________________
License Number(s): 971259
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: X Hydrostatic Vacuum Other
(Specify)____________________________ Test Equipment Used: Visual Equipment Resolution:
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1 DSL Fill 2 91 UL Fill 3 4
Bucket Installation Type: X Direct Bury
Contained in Sump
X Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Bucket Diameter: 11” 11”
Bucket Depth: 12” 12”
Wait time between applying
vacuum/water and start of test: 10 min. 10 Min.
Test Start Time (TI): 15:00 15:00
Initial Reading (RI): 10.25” 10.50”
Test End Time (TF): 16:00 16:00
Final Reading (RF): 10.25” 10.50”
Test Duration (TF – TI): 1 Hr. 1 Hr.
Change in Reading (RF - RI): 0.0” 0.0”
Pass/Fail Threshold or
Criteria: 0.25” 0.25”
Test Result: X Pass Fail X Pass Fail Pass Fail Pass Fail
Comments – (include information on repairs made prior to testing, and recommended follow-up for failed tests)
The drain valves on 91&DSL buckets were repaired.
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician’s Signature:________________________________________________ Date: 5/3/2017
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.