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Spill Bucket Testing Report Form <br /> L FACILITY INFORMATION <br /> Facility Name: FASTAND EASY Date of Testing:4/25/2016 <br /> Facility Address: 10878 N.HWY 99 STOCTON CA, <br /> Facility Contact: MIKEALE Phone: <br /> Date Local Agency was notified of Testing: <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 8165409-UC <br /> 1. SPILL BUCKET TESTING INFORMATION <br /> Test Method Use: x Hydrostatic Vacuum Other <br /> Test Equipment Used: Pump Equipment Resolution: <br /> Identify Spill Bucket(By Tank LPREMIUM 2.PLUS 3.UNLEADED 4.DIESEL <br /> Number,Stored Product) <br /> Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury X Direct Bury <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" 12" <br /> Bucket Depth: 12" 12.75" 12.50" 16" <br /> Wait time between applying 5 MIN 5 MIN 5 MIN 5 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 10:00 AM 10:00 AM 10:00 AM 10:00 AM <br /> Initial Reading(RI): 11" 11.75" 11.50" 15" <br /> Test End Time(Tf): 11:00 AM 11:00AM 11:OOAM 11:OOAM <br /> Final Reading(Rf): 11" 11.75" 11.50" 15" <br /> Test Duration(Tf-Tl): 1 HR 1 HR 1 HR 1 HR <br /> Change in Reading(Rf-Rl): 0 0 0 0 <br /> Pass/Fail Threshold or Criteria: .025" .025" .025" .025" <br /> Test Results: X Pass Fail X Pass Fail X Pass Fail X Pass Fail <br /> Comments: - (include information on repairs made prior to testing,and recommended follow-up for failed tests) <br /> I hereby certify that all the information in this report is true,and in full compliance with legal requirements. <br /> Technician's Signature: Date: 4/25/2016 <br />