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• 9 <br />Spill Bucket Testing Report Form <br />SWRCB, January 2006 <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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: ESTE'S FREIGHT Date of Testing: 5/20/2016 _ <br />Facility Address: 7611 AIRPORT BLVD STOCKTON, CA 95 <br />Facility Contact: I Phone: <br />Date Local Agency Was Notified of Testing :5/12/2016 MU 3 1 20N <br />Name of Local Agency Inspector (fpresent during testing): ARIS <br />2. TESTING CONTRACTOR INFORMATION ` ` <br />CC <br />mpany Name: AFFORDA TEST 4162nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 <br />chnician Conducting Test: El Lyle D. Nimmo ® Zane A. Nimmo ❑ David A. Winkler E] Felix G. Ramirez <br />5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT <br />II Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: TAPE MEASURE. H2O <br />Equipment Resolution: 1/16" <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 DIESEL <br />2 <br />3 <br />4 <br />Bucket Installation Type: <br />® Direct Bury <br />❑ Contained in Sump <br />E] Direct Bury <br />El Contained in Sump <br />E] Direct Bury <br />❑Contained in <br />Sum <br />F] Direct Bury <br />E] Contained in <br />Sum <br />Bucket Diameter: <br />11 <br />Bucket Depth: <br />i 1 <br />Wait time between applying <br />vacuum/water and start of test: <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 - Ri): <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for %ailed iesls) <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 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 />