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From: Franzen -Hill Inc. To -.12094683433 Page: 6/6 Date: 4/18/2011 9:57:59 AM <br />SWRCB, January 2006 <br />Spill Bucket TestingOlri Form <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/operatorfor submittal to the local regulatory agency. <br />0f. k 0J i. OItil <br />Facility Name: LATHROP SHELL Date of Testing: 02107/11 <br />Facility Address: 16500 S HARLAN <br />Facility Contact: NICKPhone: 209-403-3859 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): TEiEUY TRAM <br />I a 1ti cI !MINY171ITNUM 1I <br />Company Name: Franzen HUI <br />Technician Conducting Test: Steve Zwahlen <br />Credentials . X CSLB Contractor X_ICC Service Tech 0 SWRCB Tank Tester 0 Other (Specify) <br />License Number(s): A304147 — 5259508 -UT <br />Test Method Used: X H drostatic 0 Vacuum 0 Other <br />Test Equipment Used: Equipment Resolution:.01 <br />::'(; ... '.... `ate .. .:. •' : .>.::..... '\.. r.. '.Fitt' .:.:::t ry .n ", .. e. ..lf....t• <br />Identify Spill Bucket (By Tank 1 87 - gasoline <br />Number, Stored Product, etc. <br />2 91- gasoline 3 <br />4 <br />Bucket Installation Type: X Direct Busy <br />0 Contained in Sum <br />X Direct Bury 0 Direct Bury <br />0 Contained in Sump 0 Contained in Sump <br />0 Direct Bary <br />0 Contained in Sum <br />Bucket Diameter: 10" <br />IV <br />Bucket Depth: 14" <br />14.25" <br />Wait time between applying 10 min <br />vacuum/water and start of test: <br />10min <br />Test Start Time (TD: 10:00 am <br />10:30 am <br />Initial Reading (1111): 13.50 <br />13.75 <br />Test End Time (T,,): 11:00 am <br />11:00 am <br />Final Reading (RF): 13.50 <br />13.75 <br />Test Duration (TF — T�: 60 min <br />60 min <br />Change in Reading (RF - R�: 0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: X Pass 0 Fail <br />X Pass 0 Fail 0 Pass 0 Fail <br />0 Pass ❑Fail <br />Comments — (include information on repairs made prior to testin , and recommended follow -u for ailed tests) ^ <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained in this report is tri, accurate, and in full compliance with legal requirements <br />Technician's Signature: _Steve Zwahlen / <br />Date: 2/7/11 <br />' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />This fax was sent with GFI FAXmaker fax server. For more information, visit: http://www.gfi.com <br />