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Alltech Petro Inc. <br /> P.O. Boa 4208, Sonora, CA 95370 <br /> Phone: 209-532-7320; Fax: 209-533-2650 <br /> California Contractor 623541 A-Haz <br /> ICC Technician: 8005930-UT <br /> SWRCB Tank Tester: 09-1749 <br /> alltechmailAme.com <br /> Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco#658 Tracy Date of Testing: Tuesday,September 28,2010 <br /> Facility Address: 3240 W.Grrant Line Rd Tracy CA <br /> Facility Contact: Robert Mendoza Phone: 209-834-1427 <br /> Notification Date of Local Agency: <br /> Name of Local Agency Inspector:Stacy Rivera <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ®Hydrostatic ❑ Vacuum L Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket I Reg 1 2 Reg 2 3 Prem 4 <br /> Bucket Installation Type: Ll Direct Bury L Direct Bury L Direct Bury L1 Direct Bury <br /> ® In Sump ®In Sump ® In Sump ❑In Sum <br /> Wait time between applying None None None <br /> vacuum/water and start of test: <br /> Test Start Time(Tt): 8:00 8:00 8:00 <br /> Initial Reading(Rt): 1 1/2"Above Cap 1 1/4"Above Cap 13/4"Above Cap <br /> Test End Time(TF): 9:00 9:00 9:00 <br /> Final Reading(RF): 1 1/2"Above Cap 1 1/4"Above Cap 1 3/4"Above Cap <br /> Test Duration(TF—T,): 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading(RF-Rt): 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ® Pass ❑Fall ® Pass ❑ Fail ❑ Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Cleaned out the seal between bucket and lid. On second attempt cleaned bucket under foam and replaced seal at bottom <br /> of drain valve. <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: Date:9/28/10 <br />