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Spill Bucket Testing Report Form AUG <br /> W January 2006 <br /> This form is intended for use by contractors performing annual testing of UST spill contaiu%tiv oy d. A A�,JA1;and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for su``�bmitta t� v�,lQ41r,��ggl7j�Ydry agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name: WEST LANE FUELS I Date of Testing: 7/26/18 <br /> Facility Address: 3300 WEST LANE STOCKTON,CA 95204 <br /> Facility Contact: SHARON Phone: <br /> Date Local Agency Was Notified of Testing:6/27/18 <br /> Name of Local Agency Inspector(f present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 d Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ®Ed Stearns ❑ Zane A.Nimmo ❑ David A.Winkler ❑ Felix G.Ramirez <br /> 8883080-UT 8883064-UT 8883059-UT 8883072-UT <br /> Credentials': ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: TAPE MEASURE Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 87 2 91 3 4 <br /> Number, Stored Product, etc. <br /> ®Direct Bury ®Direct Bury <br /> ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type: E]Contained in ❑Contained in <br /> ❑ Contained in Sump ❑Contained in Sump SumpSum <br /> Bucket Diameter: 11 11 <br /> Bucket Depth: 137/8 143/4 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 1300 1300 <br /> Initial Reading(RI): 12 13 <br /> Test End Time(TF): 1400 1400 <br /> Final Reading(RF): 12 13 <br /> Test Duration(TF—Ti): IHR IHR <br /> Change in Reading(RF-RI): 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result: ® Pass ❑Fail ® Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail <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 /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: Date:7/26/18 <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 />