HomeMy WebLinkAbout4800 FAIRFAX ROAD (2)Spill Bucket Testing Report Form
SWRCB, January 2006
Thisform is intended, for use by contractors performing annual testing ofUST spill containment structures. The completedform and
printouts r om tests (ifapplicable), should be provided to thefacility ownerloperator.for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: Arco AM PM I Date of Testing: 7/1/2011
Facility Address: 4800 Fairfax Road, Bakersfield, CA 93306
Facility Contact: Alondra Hernandez I Phone: 661- 835 -8044
Date Local Agency Was Notified of Testing: 6/28/2011
Name of Local Agency Inspector (ifpresent during testing): Ernie Medina
2. TESTING CONTRACTOR INFORMATION
Company Name: Confidence UST services, Inc.
Technician Conducting Test: Kristopher Karns
Credentials': x CSLB Contractor x ICC Service Tech. x SWRCB Tank Tester Other (Specify)
License Number(s): #804904 #5264406 -UT #09 -1743
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: O Hydrostatic Vacuum Other
Test Equipment Used:Lake Test Equipment Resolution: 0.0625"
Identify Spill Bucket (lay Tank
Number, Stored Product, etc.
Super
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: 14.50"
Wait time between applying
vacuum /water and start of test: 5 Minutes
Test Start Time (Ti): 12:10 PM
Initial Reading (R,): 13.00"
Test End Time (T,:): 1:10 PM
Final Reading (R,:): 13.00"
Test Duration (T,: — T,): I Hour
Change in Reading (R,: - R,): 0.00"
Pass /Fail Threshold or
Criteria: 0,0625"
Test Result: x Pass Fail Pass Fail Pass Fail Pass Fail
Comments — (include information on repairs made prior to testing, and recommendedfollow -up for.failed tests)
CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING
1 herehy certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements.
Technician's Signature: 4 iA4 Date 7/1//2011
State laws and regulations do not currently require testing to be perfonned by a qualified contractor. However, local requirements
may be more stringent.
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Invoice No.: 27214
Site: Arco AM PM
4800 Fairfax Road
Bakersfield, CA 93306
Repairs Requested: Replace and Re -Test the Super Phil Tite
Spill Bucket.
Repairs completed: We replaced the Super Phil Tite Spill
Bucket. Then ran an hour long Lake Test Which passed. Total
time on site was two hours.
Required Repairs, Still Pending:
Technician Name: Kristopher Karns
Signature: , A.
Date: 7/11/2011