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Gizz-t___ <br />"'-NTA' <br />( <br />Spill Bucket Testing Report ForAm <br />This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />, <br />FE7 <br />_115ATNEURTZOM7,72M moi, <br />Facility Name: Unocal <br />Date of Testing: 12117/14 <br />Facility Address: 2701 March Ln. Stockton, CA 95219 <br />Facility Contact: Darren Eppler (209) 473-7337 <br />Date Local Agency Was Notified of Testing: 12/11/14 <br />j Name of Local Agency Inspector (if present during testing): Fatinah Zareef <br />.2. TESTING CONTRACTOR INFORMATION <br />Company Name: Service Station Systems <br />Technician Conducting Test: Kris Bell <br />Credentialsi: [@ CSLB Contractor [K ICC Service Tech. [] SWRCB Tank Tester E] Other (Specify) <br />License Number(s): License; 485184 ICC:5297793-UT _J <br />Test Method Used: Hydrostatic E] Vacuum ❑ Other <br />Test Equipment Used: Measuring Tape Equipment Resoiution:l /16 in, <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />I Fill Bucket 2 Fill Bucket <br />01 - Re 02 - Prem <br />3 Fill Bucket 4 <br />03 - Diesel <br />Bucket Installation Type: <br />—_ <br />Direct Bury Direct Bury <br />❑ Contained in Sump E] Contained in Sump <br />M Direct Bury Direct Bury <br />E] Contained in Sump ❑ Contained in Sump <br />Bucket Diameter: <br />13,00 in. 13.00 in. <br />13.00 in. <br />Bucket Depth: <br />12.50 in. 12,00 in. <br />13,50 in. <br />Wait time between applying <br />vacuum/water and start of test: <br />5 min. 5 min. <br />5 min. <br />Test Start Time (Ti <br />9:50am 9:50am <br />10:20arn <br />Initial Reading (R fi <br />12.50 in. 12,00 in. <br />13.00 in. <br />Test End Time (TF): <br />10:50am 10:50am <br />11:20arn <br />Final Reading (F� ): <br />12.50 In. 12.00 in. <br />13.00 in. <br />Test Duration (TF -Ti): <br />1,00 hr. 1.00 hr. <br />1.00 hr. <br />Change in Reading (RF - R, <br />0.000 in. 0,000 in. <br />0.000 in. <br />I Pass/Fail Threshold or Criteria* <br />ZERO LOSS ZERO LOSS <br />ZERO LOSS <br />-Test Result: <br />[@ Pass 0 Fail 0 Pass 0 Fall <br />[M Pass Fail ❑ Pass ❑ Fail <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the inIRMIaWn co_igained In this report Is true, accurateand in full compliance Wth loyal requirements. <br />Technician's <br />Date. 12/17/14 <br />1 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 />