HomeMy WebLinkAbout4901 UNION AVENUE (5)SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing of UST spill containment structures. The completed_form and
printoutsfrom tests (ifapplicable), should he provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: 4775 Chevron (North) I Date of Testing: 8/12/2011
Facility Address: 4901 South Union Avenue, Bakersfield, CA 93307
Facility Contact: Omero Garcia Phone: 661- 393 -7000
Date Local Agency Was Notified of Testing
Name of Local Agency Inspector (rfpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bradley Seykora
Credentials: X CSLB Contractor X iCC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s): CSLB #804904 ICC #81 1 1231
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625'
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1 Regular/ Master 2 Super 3 4
Bucket Installation Type: Direct Bury
0 Contained in Sump
Direct Bury
9 Contained in Sump
Direct Bury
Contained in Surnp
Direct Bury
Contained in Sum
Bucket Diameter: 12.00" 12.00"
Bucket Depth: 11.00- 11.001,
Wait time between applying
vacuum /water and start of test:
5 min. 5 min.
Test Start Time (Ti): 11:45 A.M. 11:45 A.M.
Initial Reading (Rj): 9.50" 9.00"
Test End Time (TF): 12:45 P.M. 12:45 P.M.
Final Reading (RF): 9.50" 9.00"
Test Duration (TF — Tj): 1 hour I hour
Change in Reading (RF - Ri): 0.00" 0.00"
Pass /Fail Threshold or
Criteria: 0.0625' 0.0625"
Test Result: Pass Fail N Pass Fail Pass Fail Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
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.
Techr Date: 8/12/2011
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
SWRCB, January 2006
Spill Bucket Testing Report Form
This, form is intendedfor use by contractors performing annual testing ofUST spill containment structures. The completedform and
printoutsfrom tests (fapplicable), should be provided to thefacility owner /operatorfor submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: #725 Fastrip # 19 (South) I Date of Testing: 8/12/2011
Facility Address: 4901 South Union Avenue, Bakersfield, CA 93307
Facility Contact: Omero Garcia Phone: 661- 393 -7000
Date Local Agency Was Notified of Testing:
Name of Local Agency Inspector (ifpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST Services, Inc.
Technician Conducting Test: Bradley Seykora
Credentials: X CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s): CSLB #804904 ICC #81 1 1231
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: x Hydrostatic Vacuum Other
Test Equipment Used: Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (By Tank
Number, Slored Product, etc.)
1 Diesel 2 3 4
Bucket Installation Type: Direct Bury
x Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sum
Bucket Diameter: 12.00"
Bucket Depth: 11.25"
Wait time between applying
vacuum /water and start of test:
5 min.
Test Start Time (Ti): 11:45 A.M.
Initial Reading (Rj): 9.00"
Test End Time (TA 12:45 P.M.
Final Reading (RF): 9.00"
Test Duration (TF — Tj): I hour
Change in Reading (RF - Ri): 0.00"
Pass /Fail Threshold or
Criteria: 0.0625"
Test Result: Pass Fail Pass Fail Pass Fail Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -upforfailed tests)
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: 8/12/2011
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.