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J s <br /> Spill Bucket TestingReport Form SWRCB,January 2006 <br /> This form is intended for use by contractors performing annual testig of IST spill containment structtir <br /> printouts from tests (if applicable), should be provided to the facility owner/operator far submittal to the local regulatory agoncrr,d <br /> 1rRT <br /> FACILITY INFORMATION <br /> Facility Name: A.G SPANOT CENTER <br /> Facility Address: 4800 S AIRFWAY IN I' <br /> �����Phon�e- 2�09-982�- .' <br /> Date of Testing: 2-23-11 - <br /> Facility Contact: THOMAS ' <br /> Date Local Agency Was Notified of Tes ng : 0 <br /> Name of Local Agency Inspector(ifpresent during testing): MOONEY <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA FEST 416 2n'Street Galt, CA 95632 <br /> (209)744-0112 Fax:. (209) 744-01 16 <br /> Technician Conducting Test; ❑ yIe D. Nimmo ❑ Zane A. Nimmo David A. Winkler <br /> 52491 i5-UT 5263322-UT Felix G. Ramirez <br /> r 5263373-UT 5273934-UT <br /> Credentials : ® ICC Set'% cc Tech. SWRCB Tank Tester — <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: [9 Hydrostatic <br /> ❑ Vacuum ❑ Other <br /> Test Equipment Used: h20 and tape measure <br /> Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank l jet fuel 1 <br /> 2 JET FUEL 2 3 JET 3 4 <br /> N2rntbet•, Stored Product, etc.) <br /> Bucket Installation Type: El Direct Bury Z Direct Bury Direct Bury ❑ Direct Bury <br /> El Contained in Sump ❑Contained in Sump Contained in ❑ Contained in <br /> Bucket Diameter: 11 1 ! Sum Sum <br /> Il <br /> Bucket Depth: 13 13 <br /> Wait time between applying <br /> pPY• g 1 rn __ 12 <br /> vacuum/water and start of test: -- -- <br /> Test Start Time(Ti): 815 815 <br /> 815 <br /> Initial Reading(Rt): 12.50 12.75 �- <br /> ]0.50 <br /> Test End Time(TF): 915 <br /> 915915 <br /> 915 <br /> Final Reading(RF): 12.50 12.75 <br /> Test Duration (TF—Ti): IHR 1 HR <br /> IHR <br /> Change in Reading(RF-RI): 0 0 — <br /> Pass/Fail Threshold or 0 <br /> Criteria: 1/16 1116 1/16 <br /> Test Result: Z Pass ❑ Fail 17 Pass <br /> ❑ Fail Z Pass ❑ Fail [] Pass ❑ Fail <br /> COmments- (include information on repairs made prior to testing, and recommended oll©w-u far-failed tests) �.-- <br /> CERTIFICATION OF TECHNICIAN R SPONSIBLE FOR CONDUCTING PIi1S TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: <br /> Date 2-23-11 <br /> State laws and regulations do not currer tly require testing to be performed by a qualified contractor. However, local requirements <br /> may be more stringent. <br />