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0 <br />Spill Bucket Testing Report For <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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />Facility Name: YOSEMITE 76 Date of Testing: 07/20/12 <br />Facility Address: 1700 E. Yosemite, Manteca CA <br />Facility Contact: Sonny Phone: 209-823-7676 <br />Date Local Agency Was Notified of Testing: 07/16/12 <br />Name of Local Agency Inspector (rf present during testing): Muni Naidu <br />/ lorewerSION M!T-,Tu KIRIN101 oral C ►l;MIN il • ► <br />Company Name: Reliable Petroleum Services Inc. <br />Technician Conducting Test: Guadalupe Sanchez <br />Credentials': X CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) <br />License Number(s): 883706 5250451 -UT <br />3. SPILL BUCKET TESTING WFORMATION <br />Test Method Used: <br />X Hydrostatic <br />11 Vacuum <br />❑ Other <br />Test Equipment Used: Standard <br />Tape Measure <br />Equipment Resolution: -- <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />T-1 87 <br />T-2 91 <br />Bucket Installation Type: <br />X Direct Bury <br />Contained in Sump <br />X Direct Bury <br />Contained in <br />Sump <br />Direct Bury <br />Contained in Sump <br />Direct Bury <br />Contained in Sum <br />Bucket Diameter: <br />12" _ <br />12" <br />Bucket Depth: <br />13 %" <br />_ <br />141/2" <br />Wait time between applying <br />vacuum/water and start of test: <br />5 min. <br />5 min. <br />Test Start Time (Tj): <br />9:45a.m <br />9:45a.m <br />Initial Reading (Rj): <br />12 7/8" <br />13'/a" <br />Test End Time (TF): <br />10:45a.m <br />10:45a.m <br />Final Reading (RF): <br />12 7/8" <br />13 %" <br />Test Duration (TF— Tj): <br />1 Hour <br />1 Hour <br />Change in Reading (RF- RI): <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />1/16" <br />1/16" <br />Test.Resuil� .. "�, :. ' <br />s. 1� �"� <br />` : r � � ' ,.. F <br />� �*a �� `I ��f ��► � ; <br />Uomments — (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 />. T <br />Technician's Signature: '" Date:07/20/12 <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 />