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c Spill Bucket Testing Report Form 0////r This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (af applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: Valley Arco Date of Testing: 05/07/08 Facility Address: 16 E Harding Way, Stockton, CA, 95204 Facility Contact: Paul I Phone: (209) 606-3551 Date Local Agency Was Notified of Testing : 04/29/08 Name of Local Agency Inspector (rf present during testing): Garrett Backus 2. TESTING CONTRACTOR INFORMATION Company Name: EPIC Compliance Systems, Inc. Technician Conducting Test: Alvin L. Milburn Credentials 0 CSLB Contractor l] ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) License Number(s): 880430 3. SPILL BUCKET TESTING INFORMATION Test Method Used: 91 Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: Caldwell Equipment Resolution: .0025" Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 87 E 2 87 W 3 89 4 81 Bucket Installation Type: ❑ Direct Bury 0 Contained in Sump ❑ Direct Bury x❑ Contained in Sump ❑ Direct Bury 0 Contained in Sump ❑ Direct Bury ❑x Contained in Sump Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 14" 14" 14" 14" Wait time between applying vacuum/water and start of test: 5min 5min 5min S m i n Test Start Time (TI): 13:00 13:00 13:00 13:00 Initial Reading (111): 12" 0 0 0 Test End Time (TF): 14:00 Final Reading (RF): 12" Test Duration (TF — T[): 1 hr Change in Reading (RF -RI): 0 Pass/Fail Threshold or Criteria: 0 0 0 0 Test Result: El Pass ❑ Fail ❑ Pass El Fail ❑ Pass El Fail ❑Pass ❑O Fail Comments — (include information on repairs made prior to testing, and recommended %ollow-up for ailed tests) The tops of the 3 failed spill bucket fill swivel adapters are damaged and don't make a good seal with the dust caps. New adapters and caps should be installed. The 87 fills are OPW duals in one containment sump. 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. or Technician's Signature: � " — Date: 05/07/08 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.