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10172773 2/14/2020
Bill Wright Toyota
5100 Gasoline Alley Drive Bakersfield 93313
16250 Meacham Road, Bakersfield, CA 93314
Aaron Perrigo
804904 8485827 9/14/2020
FFS 1010993708 8/17/2020
Confidence UST Services, Inc. (800) 339-9930
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Include information for every underground storage tank component monitored by this monitoring system control panel. If the monitoring system
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If the facility has more components than this form accommodates, additional copies of this page may be attached.
Bakersfield 93313
804904 8485827 9/14/2020
OPW. 0148613 8/19/2020
PEI 1200
1
87 Fill
OPW
11.00”
12.00”
87 Vapor
OPW
11.00”
12.00”
Tested vapor bucket due to direct bury per Kris Karns.
Aaron Perrigo (800) 339-9930
10172773 2/14/2020
Bill Wright Toyota
5100 Gasoline Alley Drive
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: Date of Testing:
Facility Address:
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:
Technician Conducting Test:
Credentials1: CSLB Contractor ICC Service Tech. SWRCB Tank Tester Other (Specify) __________________
License Number(s):
3. SPILL BUCKET TESTING INFORMATION
Test Method Used: Hydrostatic Vacuum Other
Test Equipment Used: Equipment Resolution:
Identify Spill Bucket (By Tank
Number, Stored Product, etc.)
1234
Bucket Installation Type: Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Direct Bury
Contained in Sump
Bucket Diameter:
Bucket Depth:
Wait time between applying
vacuum/water and start of test:
Test Start Time (TI):
Initial Reading (RI):
Test End Time (TF):
Final Reading (RF):
Test Duration (TF –TI):
Change in Reading (RF -RI):
Pass/Fail Threshold or
Criteria:
Test Result: Pass Fail Pass Fail Pass Fail Pass Fail
Comments –(include information on repairs made prior to testing, and recommended follow-up for failed 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:_________________________
1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent.
Bill Wright Toyota 2/14/2020
5100 Gasoline Alley Drive Bakersfield 93313
Summer Hankins (661) 398-8697
1/31/2019
Kris Karns
Confidence UST Services, Inc.
Aaron Perrigo
804904 8485827
Lake Test 0.0625”
87 Fill 87 Vapor
11.00” 11.00”
12.00” 12.00”
5 min 5 min
9:30am 9:30am
11.25” 11.50”
10:30am 10:30am
11.25” 11.50”
1 hr 1 hr
0.00” 0.00”
0.0625” 0.0625”
Tested vapor bucket due to direct bury per Kris Karns.
2/14/2020
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