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Spill Bucket Testing Report Form APR 19 2016 WRCB,January 2006 <br /> This form is intended for use by contractors performing annual testing of UST spill contai FF�l <br /> printouts from tests(tf applicable), should be provided to the facility owner/operator fpr s o,"*k7 je-r to 1e f enc and <br /> =N,fified] <br /> ATIONg yFacilitE.F.KLUDT AND SONSDate of Testing: 4/7/16 <br /> Facili1126 E.PINE ST LODI,CA <br /> FaciliSTEVEDate LNotified of Testing:3/24/16Name nspector(ifpresent during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 <br /> (209)744-0112 Fax:(209)744-0116 <br /> Technician: ®Ed Stearns ❑Lyle D.Nimmo <br /> 5250492-UT ❑ Zane A.Nimmo El David A.Winkler [I Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: TAPE MEASURE <br /> -- Equipment Resolution: I/16 <br /> Identify Spill Bucket(fly lank I KEROSENE 2 110 OCT <br /> Number, Stored Product, etc. 3 4 <br /> Bucket Installation Type: ®Direct Bury ®Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in ❑ Contained in <br /> Bucket Diameter: 12 12 Sum Sum <br /> Bucket Depth: 12 12 <br /> Wait time between applying <br /> vacuum/water and start of test: -- <br /> Test Start Time(T,): 1330 1330 <br /> Initial Reading(RI): I I I I <br /> Test End Time(TF): 1430 1430 <br /> Final Reading(RF): 10 11 <br /> Test Duration(TF—Tt): IHR IHR <br /> Change in Reading(Rr-Rj): P 0 <br /> Pass/Fail Threshold or <br /> Criteria: 1/16 1/16 I/16 <br /> Test Result: ❑ Pass Fail ® Pass ❑ Fail <br /> ❑ Pass ❑Fail ❑ pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up far failed tests) <br /> KEROSENE BUCKET FAILED COULD NOT LOCATE LEAK POINT. <br /> TO BE REPAIRED AND RETESTED BY Elite IV. <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 Signatures <%( Date:4/7/16 <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 />