HomeMy WebLinkAbout2010 SPILL BUCKETS IIIIIII VIII III IIII 39
IE 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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency.
1. FACILITY INFORMATION
Facility Name: 4346 Fastrip#621 1 Date of Testing: 8/13/2010
Facility Address: 805 34`h Street Bakersfield,CA 93301
Facility Contact: Omero Garcia Phone: (661)393-7000
Date Local Agency Was Notified of Testing: 8/10/2010
Name of Local Agency Inspector(f present 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(Spec)
License Number(s): CSLB#804904 ICC Service Tech.#5264406-UT SWRCB#09-1743
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 1 Super 2 3 4
Number, Stored Product, etc.
Bucket Installation Type: ❑ Direct Bury ❑Direct Bury ❑Direct Bury ❑ Direct Bury
X Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum
Bucket Diameter: 12.00"
Bucket Depth: 14.25"
Wait time between applying 5 minutes
vacuum/water and start of test:
Test Start Time(Tj): 9:00am
Initial Reading(Ri): 11.75"
Test End Time(TF): 10:00am
Final Reading(RF): 11.75"
Test Duration(TF—Ti): 1 hour
Change in Reading(RF-Rj): 0.00"
Pass/Fail Threshold or 0.0625
Criteria:
Test Result: X 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: 1w1.! Date:_8/13/2010
State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements
may be more stringent. 111111'Jill 40
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