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Ji y i A SEF 2 8 WRCB,January 2006 Spill Bucket Testing Report Form !—"tom This form is intended for use by contractors performing annual testing of'UST spill c4atlinment structures. The compleied form and printouts from tests(f applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility ID: PGE095 Facility Name: Pacific Gas and Electric Company I Date of Testing: 9-13-2017 Facility Address: 4040 West Ln. Stockton CA 95204 Facility Contact: Alex Steele Phone: 209-736-6426 Date Local Agency Was Notified of Testing: 9/6/17 Name of Local Agency Inspector(f present during testing): Cesar Ruvalcaba 2. TESTING CONTRACTOR INFORMATION Company Name: TAIT Environmental Services Technician Conducting Test: Garrett Warren Credentials': ❑x CSLB Contractor ❑x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) License Number(s): A B ASB C-10 HAZ,588098 8185019 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ❑x Hydrostatic []Vacuum ❑Other Test Equipment Used: Incon TS-STS Equipment Resolution: .0006 Identify Spill Bucket(By Tank I Unleaded 2 Diesel 3 Waste Oil 4 Number, Stored Product, etc.) ❑x Direct Bury ❑x Direct Bury ❑x Direct Bury ❑Direct Bury Bucket Installation Type: ❑Contained in Sump ❑Contained in Sump []Contained in Sump ❑Contained in Sump [I On Top of AST ❑On Top of AST ❑On To of AST []On Top of AST Bucket Diameter: Bucket Depth: 14" 14" 13.50" Wait time between applying 15 min 15 min 15 min vacuum/water and start of test: Test Start Time(TI): 9:18am/9:34am 9:18am/9:34am 12:07pm/12:23pm Initial Reading(Rj): 6.4612/6.4611 5.4976/5.4976 6.7841 /6.7840 Test End Time(TF): 9:33am/9:49am 9:33am/9:49am 12:22pm/12:38pm Final Reading(RF): 6.4611 /6.4608 5.4976/5.4972 6.7840/6.7839 Test Duration(TF—TI): 15 min/15 min 15 min/15 min 15 min/15 min F hange in Reading(RF-RI): .0001 /.0003 0/.0004 .0001 /.0001 ass/Fail Threshold or .002 .002 .002 riteria: Test Result: ❑x Pass ❑Fail I ❑x Pass ❑Fail ❑x Pass ❑Fail ❑ Pass []Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) Test water was left on site. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: 66VX&ZUavi" Date: 9-13-2017 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.