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RWjEIVED SEP 2 2 201SWRCB,January 2006 Spill Bucket Testing Report For This form is intended for use by contractors performing annual testing of UST spitf and printouts from tests (f applicable), should be provided to the facility owner/opera u gENTALl"THedform A egulatory agency. 1. FACILITY INFORMATION L►#■1"9KIM �1�lir�.rt[ttJ �J.aItyr �a.�►rJr�tr Company Name: AFFORDA TEST 41.6 2°d Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 Technician Conducting Test: ❑ Lyle D. Nimmo ® Zane A. Nimmo ❑ David A. Winkler ❑ Felix G. Ramirez 5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT I Credentials': ® ICC Service Tech. ® SWRCB Tank Tester Test Method Used: ® Hydrostatic ❑ Vacuum E10ther Test Equipment Used: TAPE MEASURE, H2O Equipment Resolution: 1/16" Identify Spill Bucket (By Tank Number, Stored Product, etc. 1 2 3 4 DIESEL Bucket Installation Type: ® Direct Bury ❑Contained in Sump ❑Direct Bury ❑Contained in Sump Direct Bury ❑ Contained in Sump Direct Bury ® Contained in Sum Bucket Diameter: 1 I Bucket Depth: 15 1/2 Wait time between applying vacuum/water and start of test: -- Test Start Time (Ti): 1410 Initial Reading (RI): 15 1/2 Test End Time (TF): 1510 Final Reading (RF): 15 1/2 Test Duration (TF — TI): H R Change in Reading (RF - R,): 0 Pass/Fail Threshold or Criteria: -- -- Test Result: ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail M Pass ❑ Fail Comments — (include information on repairs made prior to testing and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature:_ Date: 8-25-16 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.