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Spill Bucket Testing Report Form <br />M"7132046uary 2006 <br />1"=4 k1- R — . <br />This form is intended for use by contractors performing annual testing of UST spill containment structdrb6i 4 )ietedform -and <br />printouts from tests (ifapplicable), should be provided to thefacility owner/operator jar submittal to the local regulatory agency. <br />L FACII.ITV INFl1RMATTAN <br />Facility Name: ESTE FFREIGHT I Date of Testing: 5/20/2016 <br />Facility Address: 7611 AIRPORT BLVD STOCKTON, CA 95206 <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing :5/12/2016 <br />Name of Local Agency Inspector (fpresent during testing): ARIS <br />L. <br />Company Name: AFFORDA TEST 416 201 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 TFCTINC TNFAAM A TTnW <br />Test Method Used: ® Hydrostatic ❑ Vacuum �. ❑ Other <br />Test Equipment Used: TAPF:MEASURE, H2O <br />Equipment Resolution: 1/I6" <br />Identify Spill Bucket (By "Tank <br />Number, Stored Product, etc. <br />I DIESEL <br />3 <br />4 <br />Bucket Installation Type: <br />® Direct Bury <br />❑ Contained in Sump <br />ump <br />tEE]Conttainedd <br />❑ Direct Bury <br />❑ Contained in <br />Sump <br />❑ Direct Bury <br />❑ Contained in <br />Sump <br />Bucket Diameter: <br />11 <br />Bucket Depth: <br />11 <br />Wait time between applying <br />vacuum/water and start of test: <br />_ <br />Test Start Time (T,): <br />1240 <br />Initial Reading (R,): <br />10 - <br />Test End Time (TF): <br />1340 <br />Final Reading (RF): <br />10 - <br />Test Duration (TF— T,): <br />HR <br />Change in Reading (RF -R,): <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />-- <br />Test Result: <br />® Pass ❑ Fail <br />❑ Pass' [:]Fail <br />❑ Pass El Fail <br />E] Pass [I Fail <br />Comments — (include information on repairs made prior to testing, and recommended fallow -up for failed tests) <br />MEASURED BUCKET WITH ARIS , BUCKET WAS EXACTLY 5 GAL. <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 eJ,� Date: 5-20-16 <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 />