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' I <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UsTspill containment structures. The corrrpletedJoan and <br /> pr•intortts from tests(if applicable),should be provided to the facility owner/'operator for submittal to lire local regulatory agenc7'. <br /> _ L FACILITY INFORMATION <br /> facility Name, Sprint Stockton Hate of Testing: 11/7/2011 <br /> Facility Address: 3807 Coronado Ave <br /> Facility Contact: Doye Phone: 21.7-663-9440 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(fpresent during testing): Garrett Backus + <br /> i <br /> 2. TESTING CONTRACTOR INFORMATION <br /> FCred=tials : <br /> pany Name: Jauregui&Culver me <br /> hnician Conducting Test: Peter Jauregui III <br /> x CSLB Contractor x ICC Service Tech. l7 SWRCB'rank Tester ❑Other(Spee) <br /> License Number(s): 708231,5315297 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: x hydrostatic ❑Vacuum D Other <br /> Test Equipment Used: Nater and Tape Measure Fquipment Resolution:0 Loss <br /> y' .. (By Wank:::_ <br /> Identify <br /> Spill Bucket Diesel 2 3 4 <br /> Number Stored Product,etc. <br /> y ❑Direct Bur <br /> Bucket Installation Type: x Direct BurY ❑Direct Bury ❑Direct Bury <br /> OContained in Sump ❑Contained in Sump ❑Contained in Sump Q Contained in Sum <br /> Bucket Diameter: 11 %," <br /> Bucket Depth: It Y," <br /> ' 'Wait time between applying � <br /> vacuum/water and start of test: 20 min <br /> Test Start Time(Ti): 9:22 — I <br /> Initial Reading(Ri): 9" <br /> Test End Time(Tr): 10:22 <br /> Final Reading(RF): g" <br /> Test Duration(Tr—T,) 1 lir <br /> Change in Reading(RF-RI): 0 change <br /> Pass/Fail Threshold or <br /> Criteria: O loss g <br /> Test Result: X Pass ❑Fail 0 Pass D Fail ❑ Pass ❑Fall [1-1 Pass Q Fail <br /> . comments—{inclhrde irifor-ruation on r epturs made prior•to testing,and recorrrrrtenrded follow-up for failetl tests} <br /> Testa er ed non hazardous and remo ed from site for A re testing. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING j <br /> I hereby certify that all the infor»tatiorr contained in this report is h rre,accurate, and hifill eorrtpldance with legal regrrdrernerrls <br /> Technician's Signature: Date:-1 1/21/2011 <br /> L 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 />