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Thisform!s intended 'SpI" B <br /> Printouts r for use by con tractors ucket Testing RePorr For <br /> fom tests(rfapplicable Per or itll SWRCB, Januar <br /> Y be f ming annual test Y 200, <br /> P ovided to the g of UST spill co <br /> Facility ,facility owner/o ntainment structures. <br /> Y Name: 1. FACII,IT Perator for submittal to the!oc lh ecom <br /> Fa MARI V INFOR ATIO Pletedjori�l�7,1 <br /> Y Address: GOLD SHELL M N gulatory agency. <br /> Facility6131 PgCIFIC <br /> Contact: AVE. Date of Testing: <br /> Date Local TRAN 8/16!11 <br /> Agency Was Notified of Testin STOCKTON, CA <br /> Name of Local Agenc g 7/29/11 Phone: 95207 <br /> Y Inspector(<fpresent during testing); <br /> GARRETT BACK US <br /> 2• TESTING CO <br /> Company NT <br /> P y Name: AFFORDA TEST RACTOR INFORMATION 2"d Street Galt, CA 95632 <br /> LJL le D.Nim (209)744-0112 Fax; <br /> Y mo ® Zane A. (209) 744-0116 <br /> Technician Conducting Test: <br /> 5249115-U7 Nimmo ❑ David A. Winkler ❑ Felix G. Ramirez <br /> Credentials: 5263322-UT 5263373-UT <br /> ®ICC Service Tech. ® S WRCB Tank Tester 5273934-UT <br /> Test.Method Used: 3• SPILL BUCKET TESTING INFORMATION <br /> _ ® Hydrostatic 11 <br /> Test Equipment Used: TAPE NIFASURE, H2O Vacuum ❑ Other <br /> Identify Spili Bucket `81' Tank 1 87 Equipment Resolution: 1/16" <br /> a'unrber, .Stored Product, etc.) 2 3 91 <br /> 4 DIESEL <br /> Bucket Installation Type: ® Direct Bury ❑Direct Bury ® Direct Bury Direct Bury <br /> ❑ Contained in Sump ❑ Contained in Sump EContained in ❑Contained in <br /> Bucket Diameter: I 1 Sum <br /> Bucket Depth: 12 11 1111 <br /> Wait time between applying 10 vacuum/water and start of test: __ - -- -- <br /> Test Start Time(TI): 0925 0925 0925 <br /> Initial Reading(RI): 11 7/8 10 7/8 10 5/8 11 <br /> Test End Time(TF): 1025 1025 1025 <br /> Final Reading(RF): 11 7/8 10 7/8 10 5/8 <br /> Test Duration(TF—T,): HR HR HR HR <br /> Change in Reading(RF-R,): 0 0 0 <br /> Pass/Fail Threshold or _ _ _- <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail <br /> Coninients— (include infavnation on repairs made prim to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Teehri�c�an's sa'Aace. Date: %11%111 <br /> _..r__..Y.,a w...,,,,,o1;f,ar1 However,10I CegUiT0i110ritS <br />