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��P 3 o zags <br /> AlltechPo.BOX <br /> ENVIRONMENTAL HEALTjhora CA 9537008 <br /> Col>7pliante without Compromise <br /> DEPARTMENT Ca'1523541 A-Haz <br /> Phone:209-532.7320 <br /> Fax:209-533-2650 <br /> mai!@alltechpetro.c,m <br /> Vap°r-Spill Bucket TCStjn "WWW-alltechpetro.com <br /> FACILITY 1NFOR Re ort Form <br /> MArION: <br /> Facility Name: Costco #658 Tracy <br /> Facility Address.' 3240 <br /> W, Grrant Line Rd Date of Testing: September 2Z, 2016 <br /> Facility Contact: Tony Haggard <br /> Tracy CA <br /> Notification Date of Local Agency. 9/15/2016 <br /> Phone: 209-834-1427 <br /> Name of Local Agency inspector: Garrett Backus <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ®Hydrostatic <br /> Test Equipment Used: 1-Hour Observed Test ❑ Vacuum ❑ Other --- <br /> Equipment Resolution: 1/16" <br /> Identi y Spill Bucket 1 87A Vapor 2 87B Vapor P 3 91 Vapor 4 Additive Aux <br /> Bucket Installation Type: ❑ Direct Bu-., ❑ Direct Bury <br /> ❑ Direct Bur <br /> ® In Sump ® In Sum ® In Sum y El Direct Bury <br /> Wait time between ® 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,): Above Cap Above Cap Above Cap Above Cap <br /> Test End Time(Tr): 10:00 am 10:00 am <br /> 10:00 am 10:00 am <br /> Final Reading (RF): Above Cap Above Cap Above Cap Above Cap <br /> Test Duration (TF—T,): 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> 1.0 Hr. <br /> Change in Reading (RF �. : 0-0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1 16° 1/16'. 1/16" 1/161, <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ® Pass ❑ Fail ® Pass <br /> ❑ Fail ® Pass ❑ Fail <br /> Comments — (includeinformatio•- in repairs made prior to testing, and recommended follow-up for failed <br /> tests) <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:4 -F� <br /> bate: 09/22/16 <br />