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r <br /> Spill Bucket Testing Report Form SWRCB,January 2006 <br /> This form is intendedfor use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(tf applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: AG Sparlos Jet Center Date of Tessin <br /> Facility Address: 4800 South Airport Ave., Stockton, California,95206 g: 2/29/2012 <br /> Facility Contact: Thomas Tilley Phone: (209)982-1550 <br /> Date Local Agency Was Notified of Testing : 2/27/2012 by Afford-A-Test <br /> Name of Local Agency Inspector(ifpresent during testing): Muniappa Naidu, Senior,R.E,H.S. <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: R&D Compliance Testing <br /> Technician Conducting Test: Ben,lamin F.Duncan Jr. <br /> Credentials': 11 CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 90-1120/ICC#5246802-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Tape Measure Equipment Resolution: I/16"x25' <br /> Identify Spill Buckct (By Tank 1 "Tank#3-Jet A 2 Tank#4-Jet A 3 Tank#5-Jet A 4 <br /> Number, Stored Product. etc.) <br /> Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury ❑Direct Bury <br /> ❑Contained in Sum ❑Contained in Sum ❑Contained in Sum Contained in Sum <br /> Bucket Diameter: III, 11" 11 <br /> Bucket Depth: 12" 14 %z" <br /> 14 %i" <br /> Wait time between applying <br /> water and start of test: 5 Minutes 5 Minutes 5 Minutes <br /> Test Start Time(T[): 2:30 2.30 2:30 <br /> Initial Reading(Rj): 10 '/a" 13" 13" <br /> *Ende(TF): 3:30 3:30 3:30 <br /> (RF): 10 %" 13" 13" <br /> (TF—TO: 1 Hour1 Haur 1Hour <br /> ding(RF-Rj: 0" 0" 0" <br /> Pass/Fail Threshold or <br /> Criteria: 1/I6"in 1 Hour 1/16"in 1 Hour 1/16"in IHour <br /> Test Result: X Pass Fail X Pass Fail X Pass Fail ❑ Pass 1a Fail <br /> Comments— (include in ormation on repairs made prior to testing, and recommended ollo v-uejbrfiailed tests <br /> Test Fluid supplied and recovered for reuse by, R& D Compliance Testing. <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 /> aor <br /> Technician's Signature: �3u,�xc Date: 2/29/12 <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 />