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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <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(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name:Fed Ex Ground Date of Testing: 8/17/2016 <br /> Facility Address: 120 S Hansen Road,Tracy,CA 95304 <br /> Facility Contact: Jessie Andrada Phone:916-826-3081 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing):unknown <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Jarrod Cooke <br /> Credentialsi: F CSLB Contractor W ICC Service Tech. F- SWRCB Tank Tester F Other(Specify) <br /> License Number(s): 8155550 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: F Hydrostatic F Vacuum Other <br /> Test Equipment Used:LAKE TEST Equipment Resolution: 0.0625 in. <br /> Spill Box#Tank T-1 Diesel Spill Box#Tank T-2 Diesel Spill Box#Tank T-3 <br /> Identify Spill Bucket(By Tank Biodiesel-Fill 1 -Direct- <br /> -Fill 1 -Direct-Grade level -Fill 1 -Direct-Grade level Spill Box# <br /> Number, Stored Product, etc.) Grade level in containment <br /> in containment sump in containment sump <br /> sump <br /> l Direct Bury C Direct Bury f Direct Bury r Direct Bury <br /> Bucket Installation Type: ro Contained in Sump r Contained in Sump Co Contained in Sump r Contained in Sump <br /> Bucket Diameter: 14.00 14.00 14.00 <br /> Bucket Depth: 14.00 15.50 15.00 <br /> Wait time between applying <br /> vacuum/water and start of test 5 min 5 min 5 min min <br /> Test Start Time(TI): 10:35:00 10:35:00 10:35:00 <br /> Initial Reading(Rl): 13.50 in. 15.25 in. 14.50 in. <br /> Test End Time(TF): 11:35:00 11:35:00 11:35:00 <br /> Final Reading(RF): 13.50 in. 15.25 in. 14.50 in. <br /> Test Duration(TF-TI): I hr 1 hr I hr <br /> Change in Reading(Rg—Ri): 0.00 in. 0.00 in. 0.00 in. <br /> Pass/Fail Threshold or Criteria: +/-0.00 +/-0.00 +/-0.00 +/- <br /> Test Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECI3NICIAN 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: 8/17/2016 <br /> 'State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. <br /> WO:2328908 <br />