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• SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors petforming annual testing of UST spill containment structures. The completed.form and <br /> printouts from tests (if applicable), should be provided to the facility ownerloperator for submittal to the local regulatoty agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: A.G SPANOS JET CENTER Date of Testing: 2-26-2010 <br /> Facility Address: 4800 S AIRPORT WAY STOCKTON CA <br /> Facility Contact: THOMAS Phone: 209-982-1550 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(ifpresent during testing): MOONEY <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 nd Street Galt, CA 95632 (209)744-0112 Fax: (209) 744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo ❑ Zane A.Nimmo [ David A. Winkler ❑ Felix G, Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': E ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> -fest Method Used: Hydrostatic ❑ vacuum ❑ Other <br /> `fest Equipment Used: h20 and tape measure Equipment Resolution: 1/16 <br /> Identify Spill Bucket (By Tank I jet fuel 1 2 JET FUEL 2 3 JET 3 4 <br /> Number, Stored Product, etc) <br /> E Direct Bury Direct Bury Direct Bury ❑ Direct Bury <br /> Bucket Installation Type: ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in ❑ Contained in <br /> Sump Sum <br /> Bucket Diameter: I 1 11 1 1 <br /> Bucket Depth: 12 14 14 <br /> Wait time between applying <br /> vacuum/water and start of test: - <br /> Test Start Time(Tr): 100 100 100 <br /> Initial Reading(Rt): 1 1 13 13 <br /> Test End Time(TF): 200 200 200 <br /> Final Reading(RF): I 1 13 13 <br /> Test Duration(TF—Tt): IHR 1 HR 1 HR <br /> Change in Reading(RF-R1): 0 0 0 <br /> Pass/Fail Threshold or 1116 1116 1/16 <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail E Pass ❑ Fail ❑ Puss ❑ Fail ❑ Pass ❑ Fail <br /> Com inents— (include information on repairs made prior to testing, and recomniet7ded follow-tip for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full complianee with legal requirements. <br /> Technician's Signature: T)--J Date 2-26-2010 <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 />