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SWRCB,January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(if applicable), should be provided to the facility owner-'operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility ID: PGE095 Facility Name: Pacific Gas and Electric Company I Date of Testing: 9/20/2018 Facility Address: 4040 West Ln. Stockton CA 95204 Facility Contact: Alex Steele I Phone:(916)439-3477 Date Local Agency Was Notified of Testing: 9/14/2018 Name of Local Agency Inspector(if present during testing): Stacy Rivera 2. TESTING CONTRACTOR INFORMATION Company Name: TAIT Environmental Services Technician Conducting Test: Pat Banbury Credentials: OCSLB Contractor D ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) License Number(s): A B.ASB C-10 HAZ,588098 ICC 5254955 INCON 1001733709 3. SPILL BUCKET TESTING INFORMATION Test Method Used: OHydrostatic ❑Vacuum []Other Test Equipment Used: INCON TS-STS Equipment Resolution: .0006 Identify Spill Bucket(Bv Tank I Unleaded 2 Diesel 3 Waste Oil 4 Number, Stored Product, etc.) ODirect Bury ODirect Bury ODirect Bury []Direct Bury Bucket Installation Type: ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump El On Top of AST []On Top of AST ❑On Top of AST []On Top of AST Bucket Diameter: 11" 11" 11" Bucket Depth: 13.5' 12.5" 13.5" Wait time between applying 15 Min 15 Min 15 Min vacuum/water and start of test: Test Start Time(Tj): 10:00 AM- 10:15 AM 9:09 AM-9:29 AM 1:29 PM-1:44 PM Initial Reading(Rj): 7.0212-7.0212 6.6715-6.6712 6.1809-6.1813 Test End Time(TF): 10:15 AM-10:30 AM 9:24 AM-9:44 AM 1:44 PM- 1:59 PM Final Reading(RF): 7.0211 -7.0209 6.6712-6.6711 6.1814-6.1814 Test Duration(TF—Ti): 15 Min- 15 Min 15 Min- 15 Min 15 Min-15 Min Change in Reading(RF-Ri): .00011 -0003 .0003-.0001 .0005-.0001 Pass/Fail Threshold or .002 .002 .002 Criteria: Test Result: O Pass ❑Fail ❑x Pass []Fail O Pass ❑Fail ❑ Pass [:]Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and infill compliance with legal requirements. Technician's Signature: Pa 9494m# Date: 9/20/2018 State laws and regulations do not currently require testing to be performed by a qualified contractor.However, local requirements may be more stringent.