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r, <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for,use by contractors pet forrraing annual testing of UST spill containment strucltires, The completed form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> I.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 Testsnb ; <br /> Naive of Local Agency Inspectnr(ifpresent during testing): MOONEY <br /> _ 2. TESTING CONTRACTOR INFORMATION <br /> Company Names: AFFORDA TEST 4162 ld Street Galt, CA 95632 (209)744-0112 Fax; (209)744-0116 <br /> Technician Conducting Tess Q Lyle D.Nimmo Q Zane A.Ninarno ® David A..Winkler © P-Qlix G. Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> CI•edentialsl; 7❑ ICC Service Tech. Z SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING_ �INFORMATION <br /> Test Method Used: Hydrostatic Vacuum Other <br /> Test Equipment Used: 120 and tape measure Equipment Resolution; 1116 <br /> identify Spill Bucket (By Tank 1 jet fuel 1 ! 2 JET)FUEL 2 3 JET 3 4 <br /> Alumber, Stored Product, etc.) ! <br /> Direct Bury Direct BuryBucket Installation Type: i ® Direct Bury Direct Bury <br /> Contained in ❑ Contained in <br /> Contained in Sump © Contained in Sump Sl1It] Sum <br /> Bucket Diameter; 11 l l 11 <br /> Bucket Depth: 12 14 14 i <br /> Wait time between applying - -_ -- - <br /> vacuum/water and start of test: - <br /> Test Start Time(Ta): 100 100 100 <br /> Initial Reading(R1); ' 11 13 13 � <br /> Test End Time(TF), 200 200 200 <br /> 1 Final Reading(RF); l i 13 13 <br /> Test Duration(Tr.—Ti): IHR 1HR 1HR <br /> Change in Reading(RF R); 0 0 0 <br /> Pass/Fail Threshold or 1116 1116 1116 <br /> Q'iteria; <br /> Test Result; <br /> _ Pass [] fail pass ❑Fail 2 Pass Q Fail Q Pass ❑ Fail <br /> CoMments— (include information on repairs made prior to testing, and recommended follow-up for.railed tests) <br /> CERTIFICATION OF TECHNICIAN RrSPONSIBLE FOR CONDUCTING TIES TtS'TING <br /> I hereby certify that Ail the information contained in this report is true,aecurate,1411d hi full compliance with legal requlrcmenta, <br /> Technician's Signature; T6--J Date 2-26-2010 <br /> State laws and regulations do not currently require testing to be performed by a gllatified contractor, However, §oval requirements <br /> may be more stringent. <br /> —tr d l5C 'ON �l`f 13r SOMS DV mlo :zl 010 'H 'W <br />