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9 0 <br />P.O. Box 4208 <br />Alitech. <br />Sonora CA 95370 <br />Ca: 623541 A-Haz <br />Phone: 209-532-7320 <br />Compliance without Compromise Fax: 209-533-2650 <br />mail@alltechpetro.com <br />www.alltechpetro.corn <br />Spill Bucket Testing Report Form <br />FACILITY INFORMATION: <br />Facility Name: Costco # 1031 Manteca Date of Testing: Tuesday, August 21, 2012 <br />Facility Address: 2440 Daniel St. Manteca, Ca <br />Facility Contact: Julian Ochoa Phone: <br />Name of Local Agency Inspector: Thuy Tran <br />SPILL BUCKET TESTING INFORMATION: <br />Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: 1 -Hour Observed Test <br />Equipment Resolution: 1/16" <br />Identify Spill Bucket <br />1 Reg 87A <br />2 Reg 87 B <br />3 Premium <br />4 <br />Bucket Installation Type: <br />❑ Direct Bury <br />In sum.p <br />❑ Direct Bury <br />21 In Sump <br />❑ Direct Bury <br />® In Sump <br />❑ Direct Bury <br />In Sump <br />Wait time between <br />applying vacuum/water <br />and start of test: <br />None <br />None <br />None <br />Test Start Time (Ti): <br />8:45 <br />9:00 <br />8:45 <br />Initial Reading (R,): <br />4" above cap <br />4" above cap <br />2 3/4" above cap <br />Test End Time (Tr): <br />9:45 <br />10:00 <br />9:45 <br />Final Reading (RF): <br />4" above cap <br />4" above cap <br />2 3/4" above cap <br />Test Duration (TF — T): <br />1 Hour <br />1 Hour <br />1 Hour <br />Change in Reading (RF- R,): <br />None <br />None <br />None <br />Pass/Fail Threshold or <br />Criteria: <br />1/16" <br />1/16" <br />1/16" <br />Test Result: <br />® Pass ❑ Fail <br />Z Pass ❑ Fail <br />E Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br />Both regular tanks required to be taken apert and cleaned. No parts used. Passed after cleaning. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1 hereby certify that all the information contained in this report is true, accurate, and in full compliance with <br />legal requirements. <br />Technician's Signature <br />Date: 8/21/12 <br />