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• • SMIRCH,January 2006 <br /> Spill Bucket Testing Report Fortino <br /> This form is intended for use by contractorsPerforming annual testing n/'UST spill containment struciurea. The completed form and <br /> printouts from 160 (il'applicable), should be Provided to the facility owner/operator•for submittal to the local regulatory agency. <br /> t. FACT.LTTY INFORMATION <br /> Facility Name: San Joaquin RTI) _ Date of Testing: 6/30/2010 <br /> Facility Address: 1533 E. Lindsay St,Stockton,Ca 95205 _. _._ <br /> Facility Contact: gong Smith + Phone: 209.948.5566 <br /> Date 1.0cal Agency Was Notified of'I'esting : <br /> Name of Local Agency Inspector(ifpresenl duringtestinp�: teff Wong <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPMENT CO.-INC. <br /> Technician Conducting Test: Er _ <br /> ic Molgonrd _ -.... <br /> _. <br /> Credentials': 1.1 CSL.B Contractor x ICC Service Tech, 0 SWRCB Tank Tester ❑Other(Specify <br /> License Number(5): ICC Calirornia t1ST Service Tech#5250200-UT <br /> 3. SPILL RUCI(ET TESTING INFORMATION <br /> Test Method Used: 1'.I Hydrostatic _ Ll Vacuum_ 1,1 Other -•,__ <br /> Test Equipment Used: Equipment Resolution: <br /> Number, Slor Bucket P oduct, etc) ATF GAS NEW OIL WA 8 <br /> y . p (� STE OIL <br /> x Direct Bury Direct Bury x Direct Bury x Direct Bury <br /> Bucket Installation Type: p <br /> [:I Contained in Sump x Contained in Sump Contained in Sum f.i Contained m um <br /> Bucket Diameter: <br /> I2" �2' 12" 12" <br /> Bucket Depth: i3-1/2" 14" 15" 15" <br /> Wait time between applying 30 min. 30 min. 30 min. 30 min. <br /> vacuum/water and start of test: --- <br /> rest Start Time(T,): 10:50 AT 2:45 pin N 2:45 into 2:45 pm <br /> Initial Reading(Rr): 12-1/4" 13-1/8" 14" 14.1/8" <br /> _— <br /> Iest Fnd Time(l}): 11:50 am 3:45 oh 3:45 pm 3: pm <br /> I'inalReading.(Rr): — 12-1/4" - 13-I/4" _ 14" 141/8" <br /> Test Duration(Tr Ti): r I hour t hour I hour 1 hour <br /> Change in Reading(Rr;-Ri): 0 -- . - -0- <br /> Pass/Foil <br /> 0 Pass/Fail Threshold or <br /> Test Result: x Pass D Fail x Pass Fail x pass ❑ Fail x Pass 7 Fail <br /> Comments-(include in vrnnatinn an repairs mode prior to Resting, and racamtnended follnn up,forJaRled tests___ <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> 1 herehy cerrify that all the information contained In this report U true,aeurrate, and in full compliance With legal regairen:ents. <br /> Technician'sSignature: ;1dc9140 agrcf____ _ �. Date: 6/30/2010 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br /> may be more stringent. <br />