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SWRCB,January 2006 <br /> SPILL BUCKET TESTING REPORT FORM <br /> This farm is intended for use by contractors pet forming annual testing of UST spill containment structures. The completed form and printout from <br /> tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulaloty agency. <br /> 1.FACILITY INFORMATION <br /> Facili Name:Pacific Bell Telephone Co.dba AT&T California Date of Testing:08/28/2009 <br /> Facility Address: 124 W.ELM ST..LODI,CA 95242 GEO PAR#UE020 <br /> Facility Contact:Connie Mitchell Facili Phone: <br /> Date Local Agency Was Notified of Testing:08/26/2009 <br /> Name of Local Agency lns ctor if present during testing):Aris Caca it <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test: Dan R.Luck <br /> Credentials: ®CSLB Contractor ®ICC Service Tech ❑SWRCB Tank (Other(Specify) <br /> Tester <br /> License Numbe s :A ASB HAZE C-10. 588098 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Ilydrostatic ❑Vacuum []Other <br /> Test Equipment Used:Tape Measure I Equipment Resolution: 1/16" <br /> tdentity Spill But-ket(By Tank Number, 1 UE020U001 2 3 4 <br /> S(ored Product,etc) <br /> ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type ®Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> [:]On top of AST ❑On top of AST ❑On top of AST ❑On top of AST <br /> Bucket Diameter inches 11" <br /> Bucket Depth inches 16" <br /> Wait Time between applying I hour <br /> vacuum/water and start of test <br /> Test Start Time: 10:30 am <br /> Initial Reading Ri): 15" <br /> Test End Time: 11:30 am <br /> Final Reading(Rf): 15" <br /> Test Duration: I hour <br /> Chane in Reading Rf-Ri : 0 <br /> Pass/Fail Threshold or Criteria: 10 <br /> Test Result Pass <br /> Comments:Test water removed from site.Water returned to Tait's shop labelled non-hazardous. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> 1 hereby certify that all the information contained in this report is true accurate and in full compliance with legal requirements <br /> Technician's Signabire, GI c-' ' ��' `�-- Date 08/28/2009 <br />