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SWRCB, January 2006 <br />9. SAwl Bucket Testing Repor i orm <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 />FacilityName: QUICK STUFF #7789 <br />Date of Testing: 10/17/2008 <br />Facility Address: 10858 TRINITY PKWY , STOCKTON, CA, 95210 <br />Facility Contact: MGR - DAVID COOPER <br />Phone: (2 09) 952 -22 13 <br />Date Local Agency Was Notified of Testing <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: KENNETH LEE <br />Credentials 1: <br />❑ <br />CSLB Contractor <br />E <br />ICC Service Tech. <br />❑ <br />SWRCB Tank Tester <br />[fl <br />Other (Spec) VEETEROOT <br />License Number: B 3 613 0 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: [K] Hydrostatic ❑ Vacuum E Other <br />Test Equipment Used: TAPE MEASURE <br />Equipment Resolution: VISUAL <br />Identify Spill Bucket(By Tank <br />Number, Stored Product, etc) <br />1 1 UNL FILL <br />2 2 PRE FILL <br />3 3 DIE FILL <br />4 <br />Bucket Installation Type: <br />❑ Direct Bury <br />❑X Contained in Sump <br />❑ Direct Bury <br />X❑ Contained in Sump <br />ElDirect Bury <br />XO Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sump <br />Bucket Diameter: <br />13 ' ' <br />13 ' ' <br />13 ' ' <br />Bucket Depth: <br />153/41 ' <br />141/41 ' <br />'141 ' <br />Wait time between applying <br />vacuum/water and starting test: <br />5MIN <br />5MIN <br />5MIN <br />Test Start Time (Tl ): <br />15 : 3 0 <br />15:30 <br />15 : 30 <br />Initial Reading (Ri ): <br />14 ' ' <br />131/21 ' <br />VISUAL F <br />Test End Time (TF ): <br />16 : 3 0 <br />16 : 3 0 <br />15 : 3 0 <br />Final Reading (RF ): <br />14 ' ' <br />131/21 ' <br />VISUAL F <br />Test Duration: <br />60 MIN <br />60MIN <br />1MIN <br />Change in Reading (R F - R ): <br />01, <br />oft <br />1'' <br />Pass/Fail Threshold or <br />Criteria: <br />0 , , <br />0 , , <br />0 , , <br />Test Result:idbliX❑ <br />Pass D Fail <br />ElPass ❑ Fail <br />❑ Pass X❑ Fail <br />❑ Pass 1:1 Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />DSL SPILL FAILED IT WOULD NOT HOLD 5 GAL WITH OUT LEAKING RIGHT AWAY, ALL OTHER FILLS <br />PASSED <br />CERTIFICATION OF TECBNICIAN 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 />10/17/2008 <br />1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />