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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 thefacility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> FacilityName: A.G SPANOS JET CENTER Date of Testing: 2-25-14 <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:1-22-14 <br /> Name of Local Agency Inspector(fpresent during testing): Jeff <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> El Lyle D.Nimmo ❑ Zane A.Nimmo ® David A. Winkler E] Felix G.Ramirez <br /> Technician Conducting Test: 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 /> Direct Bury LJ Direct Bury <br /> Bucket Installation Type: ®Direct Bury ® Direct Bury <br /> ❑ Contained in E]Contained in <br /> El Contained in Sump El Contained in Sump Sump Sum <br /> Bucket Diameter: 11 11 I 1 <br /> Bucket Depth: 13 13 12 <br /> Wait time between applying - _ <br /> vacuum/water and start of test: <br /> Test Start Time(T1): 9 9 9 <br /> Initial Reading(R,): 12.50 12.75 11 <br /> Test End Time(TF): <br /> 10 10 10 <br /> Final Reading(RF): 12.50 12.75 11 <br /> Test Duration(TF—T,): IHR IHR IHR <br /> Changein Reading(RF-R,): 0 0 0 <br /> Pass/pail <br /> Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result: ® Pass El Fail ® Pass El Fail ® Pass [I Fail El Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up 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 compliance with legal requirements. <br /> Technician's Signature: V "-"J Date 2-25-14 <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 />