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• • SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> ill <br /> pThis form is rintouts fromttesas(if appl'cable),edfor use by nshould be p otractors ovided to the farming cility owner/opetesting of UST rator for containment <br /> ubm�al to the local regulatstructures. The ory agency- <br /> printouts <br /> ge c tedforin and <br /> 1.FACILITY INFORMATION Date of Testing: 1/2 /2016 — <br /> Facility Name: TOKAY SHELL LODI,CA 95240 <br /> Facility Address: 420 W.KETTLEMAN LN. phone: 209-369-2790 <br /> Facility Contact: JAS 2016 <br /> Date Local Agency Was Notified of Testing:12/22/15 ARIS CACAPIT <br /> Name of Local Agency Inspector(ifpresent during testinp�: L <br /> IJC9TU r1C0/:OT0.PC��T <br /> 2.TESTING CONTRACTOR INFORMATION <br /> 209 744-0112 Fax:(209)744-0116 <br /> Company Name: AFFORDA TEST 416 2"d Street Galt,CA 95632 ( ) <br /> ❑Lyle D.Nimmo E Zane A.Nimmo ❑ David A.Winkler ❑ Felix G.Ramirez <br /> ami ez <br /> Technician Conducting Test: 5249115-UT 5263322-UT 5263373-UT <br /> Credentials': E ICC Service Tech. ®SWRCB Tank Tester <br /> 3.SPILL BUCKET TESTING H INFORMATIOLj N <br /> tatic Vacuum dros ❑ <br /> Test Method Used: ® y uipment Resolution: 1/16" <br /> Eq <br /> Test Equipment Used: TAPE MEASURE,H2O „: 3 uip OCT 4 DIESEL/ <br /> Identify Spill Bucket(By <br /> Tank 1 87 2 91 WASTE OIL <br /> Number, Stored Product, etc. Direct Bury Direct Bury <br /> E Direct Bury E Direct Bury ❑Contained in ❑Contained in <br /> Bucket Installation Type: ❑Contained in Sump ❑Contained in Sump Sum Sum <br /> 11 11 <br /> • Bucket Diameter: 11 14 13 13 - <br /> Bucket Depth: 12 <br /> Wait time between applying <br /> vacuum/water and start of test: 0840 0840 OS40 -- 0955 <br /> Test Start Time(Ti): 0840 <br /> 12 1/4 12 3/4 <br /> Initial Reading(Rt): 11 1 2 0940 0940 <br /> 0940 0940 --- 1055 <br /> Test End Time(TF): 12 1/4 12 3/4 12 3/4 --- 10 1/4 <br /> Final Reading(RF): 11 1/2 HR HR --- HR <br /> Test DurationR HR(TF-Ti):T�): 0 0 0 --- <br /> 0 <br /> Change in Reading(RF-Ri): 0 PASS --- PASS <br /> Pass/Fail Threshold or <br /> Criteria: E Pass ❑Fail Pass []Fail E Pass ❑Fail ® Pass ❑Fail'' <br /> Test Result: <br /> Comments- (include information on re airs made rior to testing, and recommended follow-up for ailed tests) <br /> ASTE OIL AND DIESEL SPILL BUCKETS IN SAME COL MN <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 /> Date: 1-20-16�_- <br /> Technician's Signature:_ — <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />