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Jul 28 06 08:48a <br />Mike Dotten 209-533-2650 <br />0 0 <br />SWRCB, January 2006 <br />Spill Bucket Testing Report Farm <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 />1. FACILITY INFORMATION <br />Paciuty Name: Olympian C:ardtock Date of Testing: Thursday, July 27, 2006 <br />Facility Address: 983 Moffat Blvd <br />Facility Contact: Nick Bokides Phone: (209) 234-1256 <br />Date Local Agency Was Notified of Testing: Friday, July 21, 2006 <br />Name of Local Agency Inspector (if present during testing): Muni <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Alltech Petro Inc, 17759 Buttercup Circle, Sonora CA 95370. (209) 532-7320 <br />Technician Conducting Test: Mike Dotten <br />Credentials: E CSLB Contractor ® ICC Service Tech. 0 SWRCB Tank Tester Other (Specify) <br />License Number(s): CSLB 623541; [CC 5259412; Tank Tester 90-1068 <br />3_ CPii.i. RiTVWIPgr Ti.`Q79mr-1 TV cn>:snXwmrremr <br />Test Method Used: ® Hydrostatic ❑ Vacuum El _ Other <br />Test Equipment Used: Tape measure Equipment Resolution: 1/16 in. <br />Identify Spill Bucket (By Tank l Diesel 2 Prem 3 Regular 4 Vapor <br />Number; Stored Product, etc <br />Bucket Installation Type: <br />® Direct Bury <br />[] 1n Sump <br />® Direct Bury Direct Bury <br />In Sump In Sump <br />Direct Bury <br />❑In Sum <br />Buc et Diameter: <br />14 <br />13.5 13.5 <br />13.5 <br />Bucket Depth: <br />1 I <br />11 1 I <br />1 I <br />Wait time between applying, <br />vacuum/water and start of test: <br />0 <br />® 0 <br />0 <br />Test Start Time (Tj): <br />9:30 <br />9:30 9:30 <br />11:00 <br />Initial Reading (&): <br />8 <br />8 g <br />8 <br />Test End Time (Tr): <br />10:30 <br />10:30 10:30 <br />12:00 <br />Final Reading (Rr): <br />8 <br />8 8 <br />8 <br />Test Duration (TF - Tj): <br />1:00 <br />1:00 1:00 <br />1:00 <br />Change in Reading (RF - Rj): <br />0 <br />0 0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />0 <br />0 0 <br />0 <br />Test Result: <br />Pass ❑ Fail <br />® Pass [--]Fail ® Pass ❑ Fail <br />® Pass ❑ Fail <br />E.unii uencs - (rnctuae enjormarjon on repairs made prior to testing and reaommendedfoltow-up j* failed tests) <br />CERTIFICATION OF TECHNICIAN RFSP'ONS.90-6-L <br />I kerebv certify that all the information contabie-Z - <br />q.. <br />lcc:illlicidn J JAaii:liUi L, tiki�: ( �� r <br />