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SWRCB, January 2006 <br />Spill Bucket Testing Report Form <br />This form is intendedfor use by contractors performing annual testing of UST spill containment structures. The comp/etedform and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. 1''AUIL1'1'Y 11NF'UKN1A <br />11 Facility Name: YRC 813 1 Date of Testing: 2/6/2017 11 <br />Facility Address: 1535 E PESCADERO AVE, TRACY, CA 95304 <br />Facility Contact: CHRIS ROY Phone: 209- -- - --y <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (ifpresent during testing): victoria <br />2- TESTING CONTRACTOR INFORMATION FEB L 8 Z01i <br />Company Name: TANKNOLOGY INC. <br />Technician Conducting Test: Steve Willems <br />Credentials: W CSLB Contractor Pr ICC Service Tech. r SWRCB Tank Tester r- Other (Specify) `-' ' ' ' <br />License Number(s): A <br />3- SPH.1. RUCKFT TF,STING INFORMATION <br />Test Method Used By: r Hydrostatic r vacuum r Other <br />Test Equipment Used: LAKE TEST Equipment Resolution: 0.0625 in. <br />Identify Spill Bucket (By Tank <br />.Number, Stored Product, etc.) <br />Spill Box # Tank motor oil <br />MOTOR OIL - Fill 1 - Direct <br />- Grade level <br />Spill Box # Tank waste oil <br />tank pad WASTE OIL - Fill <br />1 - Direct - Grade level <br />Spill Box # <br />Spill Box # <br />Bucket Installation Type: <br />R Direct Bury <br />0 Contained in Sump <br />R Direct Bury <br />f Contained in Sump <br />! Direct Bury <br />r Contained in Sump <br />R Direct Bury <br />r Contained in Sump <br />Bucket Diameter: <br />12.00 <br />12.00 <br />Bucket Depth: <br />18.00 <br />15.50 <br />Wait time between applying <br />vacuum/water and start of test <br />5 min <br />5 min <br />min <br />min <br />Test Start Time (Tl): <br />11:31:00 <br />11:31:00 <br />Initial Reading (RI): <br />17.00 im H2O <br />14.75 in. H2O <br />Test End Time(TF): <br />12:31:00 <br />12:31:00 <br />Final Reading (RF): <br />17.00 in. H2O <br />14.75 in. H2O <br />Test Duration(TF-TI): <br />1 hr <br />1 hr <br />Change in Reading (RF -RI) : <br />0.00 in. H2O <br />0.00 in. H2O <br />PassTail Threshold or Criteria: <br />+/-0.00 <br />+/-0.00 <br />+/- <br />+/- <br />Test Result: <br />Pass <br />Pass <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 the information contained in this report is true, accurate, and in full compliance with legal requirements. <br />Technician's Signature: C3 U)'9' Date: 2/6/2017 <br />'State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. <br />WO: 2329893 <br />