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RECEIVED <br /> Spill Bucket Testing Report Form MANY�Bi Jygry 2006 <br /> This form as intended for use by contractors performing annual testing of UST spall containment struc � di ' <br /> printouts from tests(af applicable), should be provided to the facility owner/operator for submittal to tt14 <br /> gy. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ALPHA FAST GAS I Date of Testing: 04-23-14 <br /> Facility Address: 2348 WATERLOO RD STOCKTON CALIFORNIA 95205 <br /> Facility Contact: JIMMY T Phone: 209-462-7502 <br /> Date Local Agency Was Notified of Testing:04-23-14 <br /> Name of Local Agency Inspector(?fpresent during testing): JEFF W ONG <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 god Street Galt,CA 95632 (269)744-0112 Fax:(209) 744-0116 <br /> Technician Conducting Test: ❑Lyle D.Nimmo Z Zane A.Nimmo ❑ David A.Winkler M Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': 0 ICC Service Tech. ❑ SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑Hydrostatic ❑Vacuum ❑ Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1/16 <br /> Identify Spill Bucket (By Tank 1 87 2 91 3 DIESEL 4 <br /> Number. ,Stored Product, etc.) <br /> ®Direct Bury ❑Direct Bury ® Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ❑ Contained in ❑ Contained in <br /> ❑Contained in Sump ❑Contained in Sump Sump Sump <br /> Bucket Diameter: 11 11 11 <br /> Bucket Depth: 13 13 15 1/2 <br /> Wait time between applying <br /> vacuum/water and start of test: - <br /> Test Start Time(Ti): 1 1.330 1330 1330 <br /> Initial Reading(Rj): 13 13 14 <br /> Test End Time(TF): 1430 1430 1430 <br /> Final Reading(RF): 13 13 14 <br /> Test Duration(TF—T[): 1 HOUR 1 HOUR I HOUR <br /> Change in Reading(RF-RI): 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: Z Pass ❑Fail IR Pass ❑ Fail ® Pass ❑Fail ❑ Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW BUCKETS <br /> CERTIFICATION OF TECBIVICIAN RESPONSIBLE FOR CONDI CTING THIS TESTINC <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with Ie{al requirements. <br /> � yyy <br /> Technician's Signature: ' Date:04-23-14 <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 />