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. _% P.O.Box 4208 <br /> AfttechfttrV ' SWone:20� 70°6 <br /> 2a`b4 1�-Ftaz <br /> Phone:209-532-7320 <br /> Compliance without Compromise Fax:209-533-2650 <br /> ma i Igal(tech petro.com <br /> Spill Bucket Testing Report Form www.alftechpetro.com <br /> 1. FACILITY INFORMATION <br /> Facility Name: Costco #038 Stockton Date of Testing: Monday,June 10, 2013 <br /> Facility Address: 1616 Hammer Lane, Stockton CA <br /> Facility Contact: Rick Mederios Phone: 209-478-2040 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector (if present during testing): Jeff Wong <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Alltech Petro Inc, P.O. Box 4208, Sonora CA 95370. (209) 532-7320 <br /> Technician Conducting Test: Isaac Anderson <br /> Credentials ® CSLB Contractor ® ICC Service Tech. ® SWRCB Tank Tester <br /> ❑ Other (Specify) <br /> License Number(s): CSLB CA 62341 A-HAZ, ICC 8164912-UT, SWRCB 09-1749 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16 <br /> Identify Spill Bucket (By 1 Fuel Additive 2 3 4 <br /> Tank Number, Stored Tank 4 <br /> Product, etc.) <br /> Bucket Installation Type: —0-Direct Bury Ll Direct Bury ❑ Direct Bur;' <br /> ury ❑ Direct Bury <br /> ® In Sump ❑ In Sump ❑ In Sump ❑ In Sum <br /> Wait time between <br /> applying vacuum/water 0 <br /> and start of test: <br /> Test Start Time (T,): 9:30 pm <br /> Initial Reading (R,): 2" above Cap <br /> Test End Time(TF): 10:30 pm <br /> Final Reading (RF): 2"above Cap <br /> Test Duration (TF-T,): 1.0 Hr. <br /> Change in Reading (RF-R,): 0.0 <br /> Pass/Fail Threshold or 1/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> ❑ Pass ❑ Fail <br /> Comments - (include information on repairs made prior to testing, and recommended follow-up for failed <br /> tests) <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: 06-10-13 <br />