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Alitech <br />Compliance without Compromise <br />Spill Bucket Testing Report Form <br />FACILITY INFORMATION: <br />P.O. Box 4208 <br />Sonora CA 95370 <br />Ca: 623541 A-Haz <br />Phone: 209-532-7320 <br />Fax: 209-533-2650 <br />mail@alltechpetro.com <br />www.alltechpetro.com <br />Facility Name: Costco # 1031 Manteca I Date of Testing: Thursday, August 18, 2011 <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 Sump <br />❑ Direct Bury <br />® In Sump <br />❑ Direct Bury <br />Z In Sump <br />❑ Direct Bury <br />❑ In Sum <br />Wait time between <br />applying vacuum/water <br />and start of test: <br />None <br />None <br />None <br />Test Start Time (T,): <br />8:20 <br />8:15 <br />8:17 <br />Initial Reading (R,): <br />4 1/8" above cap <br />4" above cap <br />3 3/16" above cap <br />Test End Time (TF): <br />9:20 <br />9:15 <br />9:17 <br />Final Reading (RF): <br />4 1/8" above cap <br />4" above cap <br />3 3/16" 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 />rZ Pass ❑ Fail <br />N Pans ❑ Fail <br />Z Pass [:]Fail <br />❑ Pass ❑ Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed <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: 8/18/1 1 <br />