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SWRCB,January 2006 9. 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: ARCO # 06020, CC 18022765 DateofTesting: 07/30/2007 Facility Address: 1711 E YOSEMITE , MANTECA, CA, 95336 Facility Contact: MANAGER Phone: (2 0 9) 823-4715 Date Local Agency Was Notified of Testing: 07/19/2007 Name of Local Agency Inspector(if present during testing): MUNIAPPA NAIDU 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: JOEY MESA Credentials I:E1 CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester E Other(Specify) ICC SERVICE License Number: 5259458-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used:TAPE MEASURE Equipment Resolution:VISUAL LOSS Identify Spill Bucket(By Tank 1 1 UNL FILL Z 2 MID FILL 3 3 PRE FILL 4 Number,Stored Product,etc.) ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury Bucket Installation Type: X❑Contained in SumpX❑Contained in Sump ❑R Contained in Sump ❑Contained in Sump Bucket Diameter: 10 1/211 10 1/211 10 1/211 Bucket Depth: 1510 1511 1511 Wait time between applying 5 MIN. 5 MIN. 5 MIN. vacuum/water and starting test: Test Start Time(TI ): 13:0 0 13:0 0 13 :0 0 Initial Reading(Rt ): 14" 14" 14" Test End Time(TF): 14 : 0 5 14 :0 5 14 :0 5 Final Reading(RF ): 1411 14" 14" Test Duration: 60 MIN. 60 MIN. 60 MIN. Change in Reading(R F-R1 ): 011 011 0" Pass/Fail Threshold or VISUAL LOSS VISUAL LOSS VISUAL LOSS Criteria: Test Result: M Pass El Fail X Pass1:1 Fail [K]Pass 1:1 Fail 0 Pass1:1 Fail COII MentS- (include in formation on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: Date:Date: 07/30/2007 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.