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S VMCB,January 2006 <br /> Spill Bucket Testing Report Farm <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(f applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> l.. FACILITY INFORMATION <br /> Facility Name: Sprint Stockton Date of Testing: 111812013 <br /> Facility Address: 3807 Coronado Ave <br /> Facility Contact: Doye Phone: 217-663-9440 <br /> Date Local Agency Was Notified of Testing: <br /> tilaEne of Local Agency Inspector(tfpresent during testing): Garrett Backus <br /> 2, TESTING CONTRACTOR INFORMATION_ <br /> Company Name: Jauregui&Culver inc <br /> Techuucian Conducting Test: Peter Jauregui III <br /> Credentidst: x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(S eco) <br /> License Number(s): 708231,8195227 <br /> 3, SPILL BUCIKET TESTING FORMATION <br /> Test Method Used: x Hydrostatic L1 Vacuum ❑Other <br /> Test Equipment Used:[Nater and.Tape Measure ]Bgaipment Resolution,0 Loss <br /> Identify SpLI Bucket(By Tank Diesel3 4 <br /> Number,Stored Product, ete. It 2 <br /> Bucket Installation Type: x Direct Bury - ❑Direct Bury CJ Direct Bury ❑Direct Bury <br /> GContained in Sump ❑Contained in Sump ❑Contained in Sump i 0 Contained in Sum <br /> Bucket Diameter: 11'/Z" <br /> Bucket Depth: 11 '/z 1, <br /> Wait time between applying 20 min <br /> vacautn/water and start of test: <br /> Test Start Time(TO: 8:54 <br /> Fnitial Reading(RO: I '/2'Down From Top <br /> Test End Time(TF): 9.54 <br /> Final Reading(RF): 'DawuF�oz l/ �„• rz? � <br /> Test Duration(TF—Tr): 1 hr <br /> Change in Reading(RF-Its}: 0 change <br /> Pass/Fail Threshold or li loss <br /> Criteria. <br /> ?; �t'Restilt r: '.; t .+ "'.r past a ::l Pa aF1 .�r.. s � D s� lN�a <br /> Comments—anclude information on repairs made prior to testing, and recommended allow-t far filled tests <br /> Test water- was deemed non hazardhazardouLmd removed from. site for ftwe testing._ <br /> CERTIFTCATION OF TECHNICIAN RIFSPOlti S BLE FOR CONDUCTING THIS TESTING i <br /> I hereby cert!,fy that all the inforptation contained in this report h hue,accurate,and In full compliance will:!egad regalratwW& <br /> Technician's Signature: Date: 11/20/2013 <br /> State laws and regulations do not currently require testing to be perfonnud by a qualified contractor.However,local requirements <br /> may be more stringent. <br />