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SWRCB, January 2006 <br />SpRI Bucket Testing Report Form <br />dforin and <br />printoutsThisfibrin ism test (fa applicable), <br />by contractors cable , should be p�fbrtning annual testing of UST rovided to the,faaTity owner/operator forill ainment structures. The submittal to the local regulatory agency. <br />printouts frau tests (if app ' ), P <br />1. FACILITY INVMYJL2 I'w" <br />Date of Testing: 4/8/10 <br />Facility Name: JAHANT FOOD &FUEL - <br />Facility Address: 243237N. HWY 99 ACAMPO, CA 95220 <br />Facility Contact: SINGH Phone 209-333-6000 <br />Date Local Agency Was Notified of Testing 2/4/10 <br />Name of Local Agency Inspector (if present during testing): <br />ARIS <br />Company Name: AFFORDA TEST 416 2"" Street Galt, CA 95632 (209) 744.0112 Fax: (209) 744-0116 <br />Test: ❑ Lyle D. Nimmo ® Zane A. Nimmo ❑ David A. Winkler El Felix G. Ramirez <br />Technician Conducting 5249115 -1 -IT 5263322 -UT 5263373 -UT 5273934 -UT _ <br />Credentials': ® ICC Service Tech. (Ej SWRCB Tank Tester - <br />H drostatio <br />Test Method Used: ® y <br />LJ Vacuum <br />u <br />u <br />Eiment Resolution: <br />qup <br />1/16" <br />Test Equipment Used: TAPE MEASURE, H2O <br />- --7r- � _.. _ <br />Identify Spill Bucket (By Tank 1 87 <br />2 89 <br />3 91 <br />4DIESEL 2 <br />Number, Stored Product, etc.) <br />® Direct Bury <br />Direct Bury <br />® Direct Bury <br />® Direct Bury <br />El Contained in <br />❑ Contained in <br />Bucket Installation Type: ❑ Contained in Sump <br />- <br />❑ Contained in Sump <br />Sum <br />Sum <br />Bucket Diameter: 1 1 <br />1 1 <br />1] <br />14 <br />11 <br />12 <br />Bucket Depth: 12 <br />13 <br />Wait time between applying <br />vacuum/water and start of test: <br />1000 <br />1000 <br />Test Start Time (Ti): 1000 <br />1000 <br />11 1/4 <br />12 1/4 <br />12 1/8 <br />ll 1/4 <br />Initial Reading (111): <br />Test End Time (TF): <br />1100 <br />1100 <br />1100 <br />1100 <br />Final Reading (RF): <br />_ <br />11 1/4 <br />12 1/4 <br />12 1/8 <br />Il 1/4 <br />Test Duration (TF -Ti): <br />HR <br />HR <br />HR <br />HR <br />Chanee in Reading (RF -Ri): <br />0 <br />0 <br />0 <br />0 <br />Pass&au-fnresnora orI <br />Criteria: <br />Test Result: Pass ❑Fall ®Pass '❑ Fail ®Pass ❑Fail ®Pass El Fail <br />Comments - (include information on repairs made prior to testing and r•ecommendedfollow-upforfciiled tests) _ <br />ALL GOOD! _ <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1 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: 4/8/10 <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 />