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4 <br /> P.O.Box 4206 <br /> CA <br /> AlltechPetr Sonora 5395320 <br /> 01 Ca:623541 A-Haz <br /> Phone:209-532-2650 <br /> Compliance without Compromise Fax:209-533-2650 <br /> 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, 2013 <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: 9/5/2013 <br /> Name of Local Agency Inspector: Thuy Tran <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ® Hydrostatic ❑ vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 87A Fill 2 87B Fill 3 91 Fill 4 Additive Fill <br /> Bucket Installation Type: [-] Direct Bury E] Direct Bury L] Direct Bury ❑ Direct Bury <br /> ® In sump In Sump 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 (T,): 8:00 10:00 8:00 10:00 <br /> Initial Reading (R): 2 1/2"Above Cap 1 1/2"Above Cap 2 1/2"Above Cap 3 1/4"Above Cap <br /> Test End Time(Tr): 9:00 11:00 9:00 11:00 <br /> Final Reading (RF): 2 1/2"Above Cap 1 1/2"Above Cap 2 1/2"Above Cap 3 1/4"Above Cap <br /> Test Duration (TF-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 or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ® 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 /> Cleaned out 87b fill bucket and replaced o-ring. Passed second attempt. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> /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: 9/25/13 <br />