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NOV-13-2013 15:13 From: 2098254549 To:4683433 F'aae:lr i7 <br /> RlfCEIVED <br /> Spill Bucket Testing Report For>W <br /> V 1.2 2013 swecB,lanaary 2oas <br /> This form is intended for use by contractors performing annual testing of UST spillf �, �'�mpfeied form ata! <br /> printouts from tests(if applicable), should be provided to the facility owner/operator7�A�t{t�P ( ,yFgulatoryagency. <br /> 1.FACILITY INFORMATION <br /> Facility Name: QUICKI KLEEN bate of Testing: 10-1(i-13 <br /> facility Address: 707 E YOSEMITE AVE MANTECA CA <br /> Facility Contact: I Phone: <br /> Date Local Agency Was Notified of Testing:9-12-13 <br /> Name of Local Agency Inspector(if present during testing): ELENA <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 21"Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test-, ❑Lyle D.Nimmu ❑ Zane A.Nimmo ® David A.Winkler ❑ Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials": ®ICC Service Tet:h. ®SWRCB Tank Tester <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: b2o and tape measure Equipment Resolution: 116 <br /> .._ --_-.. -0,4"g—- - _::z- --_. ------ <br /> Identify Spill Bucket(By Tank 1 871 2 872 3 -DSL 4 <br /> Number Stored Product,etc. <br /> - ❑Direct Bu Dircc;l Bury Direct Bury <br /> Bucket Installation Type: Bury ❑Direct ned ®Contained in Contained in <br /> ®Contained in Sump ®Contained in Sump Su Sum <br /> Bucket Diameter, it 11 11 <br /> Bucket Depth: 15 17 1.5 <br /> Wait time between applying <br /> vacuum/water and start of test, <br /> Test Start Time(T,): 1015 1015 1015 <br /> Initial Reading(R,): 14 16 14 <br /> Test End Time(T,): 1115 11 l5 1115 <br /> Final Reading(R,.): 14 16 14 <br /> Test Duration(T,:-T,)' 1HR 1HR 1HR <br /> Change in Raading(R,:-R,): 0 10 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Gest It:.. Pass ]Fair Pass ' ❑l ail �..Fess ❑Pail ❑ Paas ❑Fall <br /> COMMeRtS—(include information on repairs made prior to testing and recommended follow-up for failed tests) <br /> CERTIFICATION OR TEC'HNtClAN RE$POTi$IBLE FOR WNDUC TING THIS TESTING <br /> I hereby certify that as the infOOnn;lion contained in this report it true,accurate,and in fun compliance.ritb legal mquirea nls. <br /> Technician's Signature: IC).—J Date 10-16-13 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may he more stringent. <br />