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SWRCB. January 2006 <br />Spill Bucket Testing Report Form <br />This torm is intended fiw use hr .onrracrrws perf�wminK annual rrs►inR e!/ C :tiT spill c�Hrrwnmrnl strut►arcs The 0impleted form and <br />prinlours from rests of applicable), should he pr(wide•d to the Jaciliite rnvner rywraw for submittal to the haul rexula►on- agenc7 <br />1. FACIUTV INFORMATION <br />I acility Name: Stockton AASFDate of Testing: 7_'28'2016 <br />Facility Address- 2000 Stimson RD Stockton CA. 95206 <br />Facility Contact: Louis Pajam 1 Phone. 209-983-5331 <br />— - <br />?ate Local Agency Was Notified of Testing : 48 hr - <br />Vame of local Agency Irnpector of present during testoW- - <br />2. TESTING CONTRACTOR INFORMATION <br />ompany Name: Tank Team inc. <br />rechnician Conducting Test: Bernie ODS <br />redentialsl: x CSLB Contractor x ICC Service Tech SWRCB lank Tester Other I., rXxt it <br />I.acense Number(s): 512835 <br />A CP11 1 UNIV tCT TCCTIiN!• r1►SCtlOaa AIrld" 1 <br />Test Method Used: x IINdrostatic Vacuum -, Other <br />Test Equipment Used: tape measure <br />Equipment Resolutiow.1 16" <br />Identify Spill Bucket IRs Tank <br />I-I9k <br />2 <br />3 4 <br />Number. Stored product, etc.) <br />Hucket Installation T <br />Type: <br />x Direct Bury <br />Direct Bury <br />Direct Bury <br />Direct Bury <br />Contained in Sump <br />_ <br />Contained in Sump_ <br />_ <br />I Contained in Su_p <br />— <br />Contained in Sump <br />Bucket Diameter: <br />12- <br />- <br />Bucket Depth: <br />12" <br />30 min <br />Wait time between apply in <br />pp y g <br />vacuum.'water and start of test: <br />-- — <br />Test Start Time ( Ti)' <br />8:15 - <br />Initial Reading (RI): <br />13" <br />Test End rime (TF ►: <br />9:15 <br />Final ReWing(Rr): <br />13' <br />Test Duration IT, T,): <br />I hr <br />Change in Reading (RF - RI): <br />0 <br />Pass/Fail Threshold or <br />007„ <br />Criteria: <br />_ <br />I pas 1l Eau <br />-- <br />- - <br />Tat Rads: <br />l OOIOItOfs - I►nctuJr inlurmotiorr nn re►win suede prior to testing and reco+rrmemled follow-up 1nr1uilrJ Irsul <br />CERTIFIC WN OFT HNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING. <br />I herby certify that c ed In thla report b free. accurse, and hr full compliance witk legal rrgrireswewrs. <br />Technician's Si re, Date:728,2016 <br />State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />19 <br />