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9. S$kl Bucket Testing Repor, 'orm SWRCB, January 2006 <br />This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: QUICK STUFF #7789 <br />Technician Conducting Test: KRISTOPHER BELL <br />DateofTesting: 06/24/2009 <br />Facility Address: 10858 TRINITY PKWY @ 8 MILE <br />WEST OF HWY 5, STOCKTON, CA, 95210 <br />Facility Contact: MGR - DAVID COOPER <br />ICC Service Tech. <br />Phone: (2 0 9) 952-2213 <br />Date Local Agency Was Notified of Testing : / / <br />❑ <br />Name of Local Agency Inspector (if present during testing): <br />GARRETT <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: KRISTOPHER BELL <br />Credentials 1: <br />❑ <br />CSLB Contractor <br />E <br />ICC Service Tech. <br />❑ <br />SWRCB Tank Tester <br />❑ <br />Other (Specify) <br />License Number: 5297793 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: X❑ Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: TAPE MEASURE <br />Equipment Resolution: NO VISIBLE LOSS <br />Identify Spill Bucket(By Tank <br />Number, Stored Product, etc) <br />3 DIE FILL <br />2 <br />3 <br />4 <br />Bucket Installation Type: <br />❑ Direct Bury <br />❑X Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />Bucket Diameter: <br />1411 <br />Bucket Depth: <br />14 1/211 <br />Wait time between applying <br />vacuum/water and starting test: <br />1 MIN <br />Test Start Time (TI ): <br />8 :45 <br />Initial Reading (R I ): <br />14 1/411 <br />Test End Time (TF ): <br />9:45 <br />Final Reading (RF ): <br />14 1/4" <br />Test Duration: <br />1 HR <br />Change in Reading (R F - RI ): <br />o" <br />Pass/Fail Threshold or <br />Criteria: <br />0" <br />Test Result: <br />PassE] Fail <br />❑Pass ❑ Fail <br />❑ Pass 0 Fail <br />E]Pass ❑ Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. <br />Technician's Signature: �� Date <br />06/24/2009 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />