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n <br /> EG-,,­­_. ^cW �g <br /> SWRCB,January 2006 <br /> Ili Bucket TestingFor " <br /> This form is intended for use by contractors performing annual testing of UST spill containment struct-F The c r "' <br /> printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local re ,.,p. nd .il <br /> 1. FACILITY INFORMATION <br /> Facility Name: Unocal Date of Testing:12/14/17 <br /> Facility Address: 2701 West March Lane Stockton, CA 95219 <br /> Facility contact: Darren Eppler (209)473-7337 <br /> Date Local Agency Was Notified of Testing: 11/27/17 <br /> Name of Local Agency Inspector (if present during testing): Cesar RUvalcaba <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:Service Station Systems... <br /> Technician Conducting Test: Kris Bell <br /> Credentialsi: ®CSLB Contractor ®ICC Service Tech. ❑SWRCB Tank Tester ❑ Other(Specify) <br /> License Number(s): License:485184 ICC:5297793-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑vacuum ❑ Other <br /> Test Equipment Used: Measuring Tape Equipment Resolution:1/16 in. <br /> Identify Spill Bucket (By Tank 1 Fill Bucket 2 Fill Bucket 3 Fill Bucket 4 <br /> Number,Stored Product,etc.) 01 -Re u 02-Prem 03-Diesel <br /> ® <br /> Bucket Installation Type: Direct Bury ® Direct Bury ®Direct Bury ® Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑ Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 13.00 in. 13.00 in. 13.00 in. <br /> Bucket Depth: 13.00 in. 12.50 in. 13.50 in. <br /> Wait fime between applying <br /> vacuum/water and start of test: 10 min. 10 min. 10 min. <br /> Test Start Time IT,): 8:54am 8:54am 8:54am <br /> Initial Reading(R,): 12.250 in. 12.000 in. 10.688 in. <br /> Test End Time(TF): 9:54am 9:54am 9:54am <br /> Final Reading(I?F): 12.250 in. 12.000 in. 10.688 in. <br /> Test Duration(TF-T,): 1.00 hr. 1.00 hr. 1.00 hr. <br /> Change in Reading(RF-R,): 0.0000 in. 0.0000 in. 0.0000 in. <br /> Pass/Fail Threshold or Criteria: ZERO LOSS ZERO LOSS ZERO LOSS <br /> Test Result: IM Pass Q Fall [M Pass ❑Fait ®Pass ❑Fait ❑Pass ❑ Fall <br /> Comments: Include information on repairs made prior to testing,and recommended follow-up for failed tests. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> !hereby certify that an the Info co wined In this report is true,accurate and In full compliance with legal requirements. <br /> Technician's Signature: Date: 12/14/17 <br /> t 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 />