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Spif Bucket Testing Report FormSWACB,January 2006 <br /> sts orm is anten eWor use y—con rrac ors per orm zf- 11��y� I structures;--The completed form card <br /> printouts from tests(ifopplicable),should be provided to the facility ownerloperator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Rancho San Miguel Date of Testing: July]6,2008 <br /> Facility Address: 1427 S.Airport Way,Stockton,CA 95206 <br /> Facility Contact: Gilbert Silva Phone! 992-7620 <br /> �DateLocal Agency Was Notified of Testing $of Local Agency Inspector(afpresent during testing): % , <br /> von Flue <br /> 2. TESTING CONTRACTOR FORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPIIIENT Co. INC. <br /> Technician Conducting Test: Mike.Tones <br /> Credentials': ❑CSL$Contractor x ICC Service Tech. ❑SVvRCB Tank Tester ❑Other(Spee0) <br /> License Number(s): 5254644-UT and 5252537-'U <br /> 3. SPTLT,BUCKET TESTING INFORMATION <br /> Test Method Used: x Plydrostatic Cl Vacuum ❑Other <br /> Test Equipment Used. Equipment Resolution: <br /> Identify Spill Bucket(py Tank 1 2 3 4 <br /> Number, Stored product, etc- Re pular-Unlead <br /> Direct <br /> Bucket Insrallat;ion Type: 0 Bury ❑Aired Bury ❑Direct Bury ❑Direct Bury <br /> x Contained ire Sum -Q,Contained in SUM12 ❑Contained in Sump ❑Contained in Sum <br /> Bucket I7iattear 11"" <br /> Bucket Depth; 4" <br /> Wait time between applying <br /> vacdurn4ater incl start of test: <br /> Test Stail Titne,(TI): 9.15 a.,m. <br /> Initial Leading CRO: 13-1/4" <br /> Test End Time(TF): 10.1.5 a.m. <br /> Final Reading(RF): 13-114" <br /> Test Duration(Tp–Tr): One Hour <br /> Change in Reading(RI,-lkj: <br /> Pass/Fail Threshold or <br /> Criteria: Pass <br /> "fest Result. x Pass ❑Fail ❑ Puss 0 Fail ❑ Vass ❑Fail b Pass ❑Fail <br /> COMMent3— include information on re airs made prlor to testing, and recommended follow-up for ailed tests) <br /> INSTALLED NEW QPW 005097 1, DATE MFG. 07-07 <br /> "TESTED 1-1/2" TIROM TOP <br /> DRAIN VALVE PASSED <br /> CERTFICATION OF TE,CMNICIAI`r'`RESPONSIBLE FOR CONDUCTING TRIS TESTING <br /> .r hereby cert,that all the irtfomiallon contained in lhis'repprt i true, accurate, rind i'n full compliance with legal requirements. <br /> Technician's Signature:.9►li ares Date:July 1.6,2005 <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 /> 900 'd XVI 'HM SS31 U 900,E Nb K :90 Hr 1/800Z/N/U: <br />