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RECEIVED <br /> S 3 0 2016 <br /> P,O.Box 420$ <br /> Sonora CA 95.370 <br /> Alitech ENVIRONMENTAL HEATH Ca:623541 A-Haz <br /> Complionce without Compromise DEPARTMENT Phone:209-532-7320 <br /> Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> www.alltechpetro.com <br /> Fill _Spill Bucket Tes#in Re ort Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco #658 Tracy Date of Testing: September 22, 2016 <br /> Facility Address: 3240 W. Grrant Line Rd Tracy CA <br /> Facility Contact: Tony Haggard Phone: 209-834-1427 <br /> Notification Date of Local Agency: 9/15/2016 <br /> Name of Local Agency Inspector: Garrett Backus <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 2 878 Fill 3 91 Fill 4 Additive Fill <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® <br /> Wait time between In Sum ® In Sum ® In Sum ® In Sum <br /> applying vacuum/water None None None <br /> and start of test: None <br /> Test Start Time (T,): 9:00 am 9:00 am 9:00 am <br /> 9:00 am <br /> Initial Reading (R,): 2 1/4 above cap 1 3/4 above cap 2 1/4 above cap 2 1/2 above cap <br /> Test End Time (TF): 10:00 am 10:00 am 10:00 am <br /> 10:00 am <br /> Final Reading (RF): 2 1/4 above cap 1 3/4 above cap 2 1/4 above cap 2 1/2 above cap <br /> Test Duration (Tr--T,): 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> 1.0 Hr. <br /> Change in Reading (RF-R,): 0.0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or <br /> Criteria: 1/16" 1/16" 1/16" 1/16" <br /> Test Result: ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail ® Pass <br /> ❑ Fail <br /> Comments — (include information on repairs made prior to testing <br /> tests) and recommended follow-up for failed <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> 1 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: <br /> Date: 09/22/16 <br />