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~ • ECe.IVE® P.O.Box 4208 <br /> AlitechPetrrrrrr8 Sonora 53 95320 <br /> OCT 0 6 2014 Ca:623541 A-Haz <br /> Phone:209-532-7320 <br /> Compliance without Compromise ENVIRONMENTAL HEALTH Fax:209-533-2650 <br /> DEPARTMENT mail@alltechpetro.com <br /> w .alltechpetro.com <br /> Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco #658 Tracy Date of Testing: September 25, 2014 <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: 9/15/2014 <br /> Name of Local Agency Inspector: Elena Manzo <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: N Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 87A Fill 2 878 Fill 3 91 Fill 4 Additive Fill <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> N In Sump In Sump N In Sump In Sum <br /> Wait time between <br /> applying vacuum/water None None None None <br /> and start of test: <br /> Test Start Time(TJ: 9:45 9:45 9:45 11:40 <br /> Initial Reading (R): Y'Above Cap 2 1/2"Above Cap Y'Above Cap 3 1/4"Above Cap <br /> Test End Time(Tr): 10:45 10:45 10:45 12:40 <br /> Final Reading (Rr): 2"Above Cap 2 1/2"Above Cap 2"Above Cap 3 1/4"Above Cap <br /> Test Duration (Tr-T): 1.0 Hr. 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading (Rr-R): 0.0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: N Pass ❑ Fail N Pass ❑ Fail I N Pass ❑ Fail I N Pass ❑ Fail <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br /> tests) <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: 9/25/74 <br />