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0 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. TheMAQp2I;d?41iland <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION AVIRONMENTA! <br /> Facility Name: A.G SPANOS JET CENTER Date of Testing: 2-27-2015 <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:1-15-15 <br /> Name of Local Agency Inspector(fpresent during testing): ELENA <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 n1 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: ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: h20 and tape measure Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 Jet Fuel 1 2 JET FUEL 2 3 JET 3 4 <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: <br /> ® Direct Bury Bury®Direct Bu ®Direct Bury LlDirect Bury <br /> E] Contained in Sump ❑ EI Contained in ❑Contained inContained in Sump Sump Sum <br /> Bucket Diameter: 11 11 11 <br /> Bucket Depth: 13 13 12 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 93- 930 930 <br /> Initial Reading(R,): 12 12.75 11 <br /> Test End Time(TF): 1030 1030 1030 <br /> Final Reading(RF): 12 12.75 11 <br /> Test Duration(TF—T,): IIIA IHR IHR <br /> Change in Reading(RF-R,): 1 0 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result: I ® Pass ❑ Fail Z Pass ❑ Fail ® Pass ❑Fail ❑ Pass ❑Fail <br /> Comments— (include information on repairs made prior to testing, and recommendedfollow-upforfailed 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 compliance with legal requirements. <br /> Technician's Signature: Date 2-27-15 <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 />