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12-29-'06 10;57 FROM-61 A•Craig 7076932922 • T-227 P002/002 F-978 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended far 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: P G E Service Center Date of Testing: 12-12 06 <br /> Facility Address: 4040 West Lane Stockton CA.95204 <br /> Facility Contact: Bric Nolan Phone: <br /> Date Local Agency Was Not of Testing <br /> Name of Local Agency Inspector(if present during testing): Toua Yang <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Accu-Test/Aielio <br /> Technician Conducting Test: Eldon Hathaway Mike Aiello (p fy) <br /> Credentials': ®CSLB Contractor m ICC Service Tech. R SWRCB Tank Tester 9 Otter S eci <br /> LicenseNumber(s): SWRCB#1002 #854172 <br /> 3. SPILT.BUCKET TESTING INFORMATION <br /> Test Method Used: l4 Hydrostatic 0 Vacuum 0 Other <br /> p <br /> Test Equipment Used: VMI E q ui ment Resolution: <br /> Identify Spill Bucket(By Tank 1 REGULAR 2 WASTE OIL 3 DIESEL 4 <br /> Number,Stored Product, etc.) <br /> ®Direct Bury ®Direct Bury ®Direct Bury ®Direct Bury <br /> Bucket Installation Type: 0 Contained in Sum 0 Contained in Sum 0 Contained in Sump 0 Contained in Sum <br /> Bucket Diameter; 1T, 12„ 12„ <br /> Bucket Depth: 12" <br /> 12" 12" <br /> Wait time between applying 15 Min. 15 Min. 15 Min. <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 9:00 AM 9 00 AM Lake test 8" <br /> AM <br /> Initial Reading(Rt): Lake test 8.75" Lake test 9.25" Lake <br /> Test End Time(TF): 10:00 AM 10:00 AM 10:00 AM <br /> Final Reading(RF): 8.75" 9.251, 8 <br /> Test Duration(TF-TO: 60 Min. 60 Min. 60 Min. <br /> Change in Reading(RF-RJ: 0.0 0.0 0.0 <br /> Pass/Fail Threshold or ANY LOSS ANY LOSS ANY LOSS <br /> Criteria: 4Fai1 n Pass ❑Fail <br /> Test Result: ® Pass avail m Pass 0 Fail mpass <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 /> ,here Cert fy that all the information coniaheed in th s"', accurate,and In full compliance with legal requirements. <br /> Technician's SigaaCure: Date: <br /> ' Stats laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />