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SWRCB , January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1 . FACILITY INFORMATION Facility Name : Fast & Easy Morada #60 (Stockton ) Date of Testing : 4/11 /19 Facility Address : 10878 N Highway 99 Stockton 95212 Facility Contact : Asim Phone : (707) 393-9859 Date Local Agency Was Notified of Testing : 3-21 -19 Name of Local Agency Inspector (f present during testing) : Stacy Rivera 2 . TESTING CONTRACTOR INFORMATION Company Name : Confidence UST Services , Inc. Technician Conducting Test : Timothy Capehart Credentials : E] CSLB Contractor EIICC Service Tech . Q SWRCB Tank Tester 0 Other (Spec) License Number(s) : 804904 8414476 3 . SPILL BUCKET TESTING INFORMATION Test Method Used : ✓]Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used : Lake Test Equipment Resolution : 0. 0625" Identify Spill Bucket (By Tank 1 2 3 4 Number, Stored Product, etc. Premium-1 Premium-2 Unleaded Diesel Bucket Installation Type : 0 Direct Bury 0 Direct Bury 0 Direct Bury ® Direct Bury ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump Bucket Diameter: 11 . 0" 11 . 0" 11 .0" 11 . 0" Bucket Depth: 11 . 0" 12.5" 12. 5 12.5 Wait time between applying 5 min 5 mins 5 mins 5 mins vacuum/water and start of test : Test Start Time (Ti ) : 1 :30 1 :30 2 :30 1 :30 Initial Reading (RI ) : 11 .0" 12.0" 12. 0" 12.0" Test End Time (TF ) : 2 :30 2 :30 3 :30 2 :30 Final Reading (RF ) : 11 .5" 12. 0" 12 . 0" 12. 0" Test Duration (TF — Ti ) : 60 mins 60 mins 60 mins 60 mins Change in Reading (RF - Ri ) : 0 .5" 0 .0" 0.0" 0 .0" Pass/Fail Threshold or 0.0625" 0.0625" 0.0625" 0 .0625" Criteria: Test Result : ❑ Pass OK Y 0 Pass ❑ Fail 0 Pass ❑ Fail 0 Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended follolw-arp for failed tests) The premium 1 opw fill spill bucket does not hold 5 gallons. Due to being a direct buried opw spill bucket we will have to return and break concrete to make riser adjustments and replace the spill bucket and retest. Unleaded fill spill bucket failed hydrostatic test due to leaking fill cap retested with pass. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is tare, accurate, and in full compliance with legal requirements. Technician ' s Signature : Date : 4/11 /19 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.