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ti 0 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. 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 /> 1.FACILITY INFORMATION <br /> Facility Name: A.G SPANOS JET CENTER I 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 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 /> Credentialsl: ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑ Vacuum ❑ O—flier <br /> Test 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 /> ® <br /> Bucket Installation T Direct Bury ❑ Direct—Bury <br /> e: ® Direct Bury ® Direct Bury L]Contained n <br /> Contained in Sum <br /> ❑ ❑ Contained in <br /> Sump ❑Contained in Sump SumpSum <br /> Bucket Diameter: I I 11 11 <br /> Bucket Depth: 13 13 12 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 93- 930 930 <br /> Initial Reading(Rt): 12 12.75 11 <br /> Test End Time(TF): 1030 1030 1030 <br /> Final Reading(RF): 12 12.75 11 <br /> Test Duration(TF—Ti): IHR IHR IHR <br /> Change in Reading(RF-Ri): 0 0 0 <br /> Pass/Fail Threshold or 1/16 1 <br /> Criteria: /16 1/16 <br /> Test Result: Pass ❑Fait ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass <br /> ❑ Fail <br /> Comments– (include information on repairs made prior to testing, and recommended follow-up or 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 compliance with legal requirements. <br /> Technician's Signature: vt &— 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 />