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REGaVEL <br /> Spill Bucket Testing Report Form U-C 31 2015 <br /> 1. FACILITY INFORMATION ERlV L <br /> Facility Name: MARCH&BIANCHI Date of Testing: 11/25/1015 H�4�Tu nra4RTtscp, <br /> Facility Address: 1916 E MARCH LANE STOCKTON,CA.95202 <br /> Facility Contact: GET Phone: 209-9544945 <br /> Date Local Agency was notified of Testing: 10/19/2015 <br /> Name of Local Agency Inspector(if present during testing:) <br /> 2.TESTING CONTRACTOR INFROMATION <br /> Company Name:Mid Valley Consulting&General Engineering <br /> Technician Conducting Test:Jason Haase <br /> Credentials: CSLB Contractor ICC Service Tech. SWRCB Tank tester <br /> License Number(s): 920985 8165490-UT <br /> 1. SPILL BUCKET TESTING INFORMATION <br /> Test Method Use: s Hydrostatic Vacuum Other <br /> Test Equipment Used: Pump Equipment Resolution: <br /> Identify Spill Bucket(By Tank L UNLEADED 2.PREMIUM 3.DIESEL 4 <br /> Number,Stored Product) <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 15.25" 1550" 14.75" <br /> Wart time between applying 15 MIN 15 MIN 15 MIN <br /> vacuum/water and start of test: <br /> Teat Start Time(TI): 9:00 am 9:00 am 9:00 am <br /> Initial Reading(Rl): 14.25" 1450" 13.75" <br /> Test End Time(Tf): 10:00 am 10:00 am 10:00 am <br /> Final Reading(Rt): 14.25" 1450" 13.75" <br /> Test Duration(Tf—Tl): 1 HR IHR 1 HR <br /> Change in Reading(Rf-Rl): 0 0 0 <br /> Pass/Fail Threshold or Criteria: .025" .025" .025" <br /> Test Results: X Pass Fail X Pass Fail I X Pass Fall Pass Fail <br /> Comments: - (include information on repairs made prior to testing,and recommended follow-up for failed tests) <br /> Certification of Technician Responsible for Conducting This Testing <br /> I hereby certify that all th ' o ation in this report is true,and in full compliance with legal requirements. <br /> Technician's Signatu `"�+ Date: 11/25/2015 <br />