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P.O.Box 4208 <br /> AlltechPetn Sonora 41 9-Haz <br /> Ca:623541 -7320 <br /> Phone:209-532-7320 <br /> Compliance without Compromise Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> www.alitechpetro.com <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from <br /> tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Arco 2186 Date of Testing: Monday, February 11, 2013 <br /> Facility Address: 3212 N. California St. Stockton, CA 95204 <br /> Facility Contact: Wendy Phone: 209-941-2694 <br /> Date Local Agency Was Notified of Testing : 1/23/13 <br /> Name of Local Agency Inspector (if present during testing): Garrett Backus <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Alltech Petro Inc, P.O. Box 4208, Sonora CA 95370. (209) 532-7320 <br /> Technician Conducting Test: Isaac Anderson <br /> Credentials': ® CSLB Contractor ® ICC Service Tech. ® SWRCB Tank Tester ❑ Other (Specify) <br /> License Number(s): CA: 623541 A-Haz ICC 8146912-UT SWRCB 09-1749 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: One Hour observed test Equipment Resolution: 1/16" <br /> Identify Spill Bucket (By Tank 1 87 Master Vapor 1 2 87 Master Vapor 2 3 87 Slave Vapor 4 91 Vapor <br /> Number, Stored Product, etc.) <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® In Sump In Sump ® In Sump In Sum <br /> Wait time between applying <br /> vacuum/water and start of 0 0 0 0 <br /> test: <br /> Test Start Time(T): 11:00 am 11:00 am 11:00 am 11:00 am <br /> Initial Reading (R): Top of cap Top of cap Top of cap Top of cap <br /> Test End Time (TF): 12:00 pm 12:00 pm 12:00 pm 12:00 pm <br /> Final Reading (RF): Top of cap Top of cap Top of cap Top of cap <br /> Test Duration (TF—T): 1.0 hr 1.0 hr 1.0 hr 1.0 hr <br /> Change in Reading (RF-R): 0.0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or Criteria: 1/16" 1/16" 1/16" 1/16" <br /> Test Result: ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail I ® 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 /> l hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: Date: 02/11/13 <br />