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SWRCB, January 2006 Spill Bucket Testing Report Form .This form is intended for use by contr•actor•s performing annual testing of UST spill containment structures. The completer) for•rn and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1, FACILITY INFORMATION 2. TESTING CONTRACTOR INFORMATION Company Name: ELITE N CONTRACTORS Technician Conducting Test: 1C Credentials': CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ( Comments — (include information on repairs made prior Hydrostatic Vacuum Other Test Equipment Used: H2O Equipment Resolution: Facility Names: Vanco Truck — Auto Plaza Date of Testing: 6-20-2018 Facility Address: 1033 W Charter Way Stockton Ca 95206 Facility Contact: Mike Boparai Phone: 209-466-0833 4 Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury Contained in Sump 2. TESTING CONTRACTOR INFORMATION Company Name: ELITE N CONTRACTORS Technician Conducting Test: 1C Credentials': CSLB Contractor X ICC Service Tech. SWRCB Tank Tester Other (Specify) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ( Comments — (include information on repairs made prior Hydrostatic Vacuum Other Test Equipment Used: H2O Equipment Resolution: Identify Spill Bucket (B); Tank Number, Stored Product, etc.) 187 2 Diesel North 3 Diesel South 4 Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury X Contained in Sump Direct Bury Contained in Sump Bucket Installation Type: Bucket Diameter: Bucket Depth: Wait time between applying vacuum/water and start of test: Test Start Time (Tj): Initial Reading (Rj): Test End Time (TF): Final Reading (RF): Test Duration (TF — Tj): Change in Reading (RF - Rj): Pass/Fail Threshold or Criteria: Test Result: Pass X Fail Pass X Fall Pass X Fail ❑ Pass ❑ Fail to testing, and recommended follow-up for• failed tests) 0/ bucket —Bad Gasket Diesel North Bucket — Bad Drain & Gasket Diesel South Bucket — Bad Drain .We�('TlrvPr,�hnc, -�0I1orl hfi 01? "i1t) 0� (Pr m TION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the inforrrzatiorz contained in this report is true, accurate, and in fall compliance with legal r•egrriren:eras. Technician's Signature: Date: 1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements maybe more stringent.