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0 0 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of LIST 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 /> Facility Name: Stockton AASF Date of Testing: 9/16/08 <br /> Facility Address: 2000 Stimson RD Stockton CA.95206 <br /> Facility Contact: MSG Pica Phone: 209-983-5331 <br /> Date Local Agency Was Notified of Testing: 9/08 <br /> Name of Local Agency Inspector(f present during testing): Muniappa Naidu San Joaquin CO. <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Tank Team inc, <br /> Technician Conducting Test: Hector Galindo <br /> Credentials': x CSLB Contractor x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 512835 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: x Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Incon is sts Equipment Resolution:.002" <br /> Identify Spill Bucket(By Tank 1-15k 2 3 4 <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: x Direct Bury Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 12" <br /> Bucket Depth: 12" <br /> Wait time between applying 30 min <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 8:23 8:38 <br /> Initial Reading(Rj): 6.4704" 6.4699" <br /> Test End Time(TF): 8:38 8:54 <br /> Final Reading(RF): 1 6.4700" 6.469T' <br /> Test Duration(TF—TI): 15 min 2 x <br /> Change in Reading(RF-Rr): .0004" .0002" <br /> Pass/Fail Threshold or .002" <br /> Criteria: <br /> Test Result: x 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 in ormat' n contained in this report Is true,accurate,and in full compliance with legal requirements. <br /> 0(, <br /> Technician's Signature: Date: Ot I <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 />