HomeMy WebLinkAbout4200 ASHE ROAD (6)SWRCB, January 2006
Spill Bucket Testing Report Form
Thisform is intendedfor use by contractors performing annual testing ofUSTspill containment structures. The completedform and
printoutsfrom tests (ifapplicable), should beprovided to thefacility owner /operatorforsubmittal to the localregulatory agency.
1. FACILITY INFORMATION
Facility Name: PANAMA BUENA VISTA USD Date of Testing: 9/2/11
Facility . Address: 4200 ASHE ROAD, BAKERSFIELD
Facility Contact: I Phone:
Date Local Agency Was Notified ofTesting: 8125/11
Name of Local Agency Inspector (r "present during testing):
2. TESTING CONTRACTOR INFORMATION
Company.Name: RICH'ENVIRONMENTAL
Technician Conducting Test: RICH PHILLIPS
Credentials': C CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify)
License Number(s): 1035169 -UT
3. SPILL BUCKET TESTING INFORMATION
Test Method. Used: X Hydrostatic Vacuum 11 Other
Test Equipment Used: VISUAL Equipment Resolution: 0
Identify Spill Bucket (By Tank
Number, Stored Product, etc)
1 2 3 4
Bucket Installation Type: p Direct Bury
C Contained in Sump
Direct Bury
Contained in Sump
D Direct Bury
0 Contained in Sump
C Direct Bury
Contained in Sum
Bucket Diameter: 12" 12" 12"
Bucket Depth: 14" 14" 14"
Wait time between applying
vacuum /water and start of test:
30 MIN 30 MIN 30 MIN
Test Start Time (Ti): 9 :15 9:30
Initial Reading (Rj): 2.647 2.646
Test End Time (TF): 9:29 9:45
Final Reading (RF): 2.646 2.646
Test Duration (TF — TO: 15 15 1 -HOUR 1 -HOUR
Change in Reading (RF - RI): 001 000
Pass/Fail Threshold or
Criteria::`
002 002 0.00 0.00
Comments — (include information on repairs, made prior to testin& andrecommendedfollow -upforfailed tests)
CERTIFICATION OF TEC CLAN RESPONSIBLE FOR CONDUCTING THIS TESTING
1 hereby certify that all the Information Inedin this -report Is true, accurate, and In fullcompliance with, legal requlrenwnts.
Technician's Signature: Date: 9/2/11
State laws and regulations do not currently require testing to be performed by -a qualified contractor. However, local requirements
may be more stringent.
PANAMA SCHOOL DIST
9;209,ASHE RD
CA
09/02/2011 9:29 Art
SI MP LEAK; 'i EST REPORT
W:ST OIL
9:14 Am
TEST STARTED 09442011
BEGIN L0.,E . '2.6476 IN
END .TIME 9:29 Ate
END :DATE 09/k/2011
END LEVEL 2.6469..IN
LEAK ' lWa4OLD 0.002 IN
TEST RESEJLT PASSED
i
PFKkgA'.SCHOOL ,DIST
4-200 : ASHL RD
EtFYEkRSrltL:i7: C.A ..
9:45. AM
SUMP' ! EAK TESL -41 !RT
WST OIL
TEST. STARTED 9'30 M
TEST STARTED 09/01/2011
BEGIN L£Va .2.6469 iN
END TIME 9:45 HM
END DATE 09/02/2011
END LEVEL 2.6465 IN
LEAK THR tOL.D 0.002"TM
TEST RESULT PASSED
I