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• SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: SHELL OIL COMPANY I Date of Testing: 10/16/06 <br /> Facility Address: 3515 NAVY DRIVE,STOCKTON,CA 95203 <br /> Facility Contact: TOM EIKEMEIRER I Phone: 916-997-0054 <br /> Date Local Agency Was Notified of Testing: 48 HOURS PRIOR(MIN) <br /> Name of Local Agency Inspector(if present during testing): SAN JOAQUIN COUNTY HAZMAT <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SYSTEMS <br /> Technician Conducting Test: MICHAEL L. STRAWN,lI <br /> Credentials: ®CSLB Contractor 2 IICC Service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number(s): A B ASB C-10 HAZ License Number: 588098 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic Vacuum Other <br /> Test Equipment Used: VISUAL/MEASURE Equipment Resolution: <br /> Identify Spill Bucket(By Tank I RECLAIM TANK 2 3 4 <br /> Number, Stored Product, etc.) FILL BUCKET <br /> Bucket Installation Type: ®Direct Bury Direct Bury Direct Bury Direct Bury <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sum <br /> Bucket Diameter: 12" <br /> Bucket Depth: 11" <br /> Wait time between applying <br /> vacuum/water and start of test: 15 MINUTES <br /> Test Start Time(7170: 9:05 A.M. <br /> Initial Reading(Rt): 10 3/4" <br /> Test End Time(TF): 10:05 A.M. <br /> Final Reading(RF): 10'/a" <br /> Test Duration(TF-Tj): I HOUR <br /> Change in Reading(RF-Rj): 0" <br /> Pass/Fail Threshold or 002„ <br /> Criteria: <br /> Test Result: EI Pass Fail Pass Fail Pass Fail Pass Fail ' <br /> _Comments-(include information on repairs made prior to testing and recommended follow-up orfailed tests) <br /> *All hydrostatic test water was dropped/pumped into the underground reclaim tank per Shell <br /> Personnel. No test fluid was left on site. <br /> *The reclaim spill bucket passed. No repairs are needed at present time. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the informati�tained in this report is true,-decuratg, and in full compliance with legal requirements. <br /> Technician's SignaturDate: 10/16/06 <br /> i <br /> State laws and regulations do not currently retire-testi oe performed by a qualified contractor.However, local requirements <br /> may be more stringent. <br />