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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> Thts,form is intended for use Uy contractor,c performing annual Testing of UST spill containment structures. The completed form and <br /> prininuts font testy(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Estes Trucking Date of Testing: May 17,2010 <br /> Facility Address: 7611 S. Airport Way,Stockton,CA 95206 <br /> Facility Contact: Mark Hancock and Jim Bunck phone: 7143893.6140 <br /> Date Local Agency Was Notified of Testing: May 17,2010 <br /> Name of Local Agency Inspector(iifp•esem daring testing): Thuy Tran <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPMENT CO. INC. <br /> Technician Conducting Test: Eric Molgaard <br /> Credentials: I.J CSLB Contractor X TCC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec6) <br /> License Ntimber(s): 52502000T <br /> 3. SPiLL BUCKET TESTiNG MORMATION <br /> 'fest Method Used: X Hydrostatic 11 Vacuum _ ❑Other _ <br /> Test Equipment Used: Tape y Equipment Resolution: 1/32 in <br /> identify Spill Bucket(fly Tank 1 2 3 <br /> 4 <br /> Number, Stored product, etc.) Diesel <br /> X Direct Bury fl Direct Bury D Direct Bury 11 Direct Bury <br /> Bucket Installation Type: I;I Contained in Sump fl Contained in Sum LI Contained in Sum U Contained in Sum <br /> Bucket Diameter: 12 inch _ <br /> Bucket Depth: 14-1/2 inch <br /> Wait time between applying 5 minutes <br /> vacuum/water and start o4 test: _ <br /> Test Start Time(T,): 1:00 pm .,,•....—. <br /> Initial Reading(Ri): 14-7/16 inch <br /> 'fest End Time('1},); 2:00 pm <br /> Final Reading(RF): 14-7/16 inch <br /> Test Duration (T7—Tr): 1 hour — <br /> Change in Reading(Ry-Rr): -0- ____„_ <br /> pass/Fail Threshold or a 1/16 inch <br /> Criteria: <br /> Test Result: X Pass ❑ Fail ❑ Pass ❑ Fail IJ Pass I7 Fall ❑ Pass ❑Fall <br /> Comments (include information on repairs made prior to Gestin! and recommended fo/!aw rrp for•failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE MOR CONDUCTING THIS TESTING <br /> i herehv cernJy that all the information contained in this report is trite, accurate,and in full compliance with legal requirements. <br /> Technician's Signature: ' •ric--;A1..o ' aardi7rc � Date: May 17,2010 <br /> State laws and regulations do not currently regtesting to be performed by a qualified contractor. However, local requirements <br /> may be more stringent. <br />