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RECEIVED <br /> SJF51v G 1��J 2006 <br /> Spill Bucket Testing Report Form CA',, a 2006 <br /> This form is intended for use by contractors performing annual testing of UST spill containment structtlwl.IWiI"MEN h/�11L <br /> printouts from tests(tf applicable), should be provided to the facility owner/operator for submittal to the lfi'r 5XAMr FPfiW"E�,IT <br /> 1.FACILITY INFORMATION <br /> Facility Name: QUICK KLEEN I Date of Testing: 10-22-14 <br /> Facility Address: 707 E YOSEMITE AVE MANTECA CA <br /> Facility Contact: I Phone: 209-814-3726 <br /> Date Local Agency Was Notified of Testing:9-26-14 <br /> Name of Local Agency Inspector(ifpresent during testing): SAN JOAQUIN CO <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑Lyle D.Nimmo ❑ Zane A.Nimmo ❑ David A. Winkler ® Felix G. Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials: ® 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 Re,,dution: 1/16 <br /> TV <br /> Identify Spill Bucket(By Tank 1 87 2 87 3 91 4 <br /> Number, Stared Product, etc. <br /> Direct Bury Lj Direct Bury <br /> Bucket Installation Type: <br /> E]Direct Bury El Direct Bury ®Contained in El Contained in <br /> ®Contained in Sump ®Contained in Sump Sump Sum <br /> Bucket Diameter: 1 I 11 11 <br /> Bucket Depth: 14 14 14 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 935 1040 935 <br /> Initial Reading(R,): 13 13 13 <br /> Test End Time(TF): 1035 1140 1035 <br /> Final Reading(RF): 13 13 13 <br /> Test Duration(TF—T,): 1 HOUR 1 HOUR 1 HOUR <br /> Change in Reading(RF-R,): 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: ® Pass ❑Fail ® 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 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:10-22-14 <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 />