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P.O.Box 4208 <br /> All techPetr'e- OFSo^ora CA 9530 <br /> Ca:623541 A-Haz <br /> Phone:209-532-73220 <br /> Compliance without Compromise Fax:209-533-2650 <br /> mail®alkechpetro.com <br /> www.alltechpetro.com <br /> Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco #658 Tracy Date of Testing: September 21, 2011 <br /> Facility Address: 3240 W. Grrant Line Rd Tracy CA <br /> Facility Contact: Troy Dominici Phone: 209-834-1427 <br /> Notification Date of Local Agency: 9/14/11 <br /> Name of Local Agency Inspector:Thuy Tran <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ® Hydrostatic ❑ vacuum El Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 Reg 1 2 Reg 2 3 Prem 4 <br /> Bucket Installation Type: El Direct Bury Lj Direct Bury El Direct Bury Lj Direct Bury <br /> ® In Sump ® In Sump ® In Sump ❑ In Sum <br /> Wait time between <br /> applying vacuum/water None None None <br /> and start of test: <br /> Test Start Time(T): 8:15 10:55 8:15 <br /> Initial Reading (R,): 1"Above Cap 1 1/4"Above Cap 7/8"Above Cap <br /> Test End Time(T,): 9:15 11:55 9:15 <br /> Final Reading (R,): 1"Above Cap 1 1/4"Above Cap 7/8"Above Cap <br /> Test Duration (T,-T,): 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading (RF-R,): 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1/16" 1/16' 1/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail I ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments - (include information on repairs made prior to testing, and recommended follow-up for failed <br /> tests) <br /> The 87b bucket failed on first attempt. Re adjusted the tightness of the drain valve and bucket passed on <br /> second attempt. <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 <br /> legal requirements. <br /> Technician's Signature: Date: 9/21/11 <br />