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0 WO-8842 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report or <br /> This.16rin is intended for use b'it contractors performing anneal testing of'UST spill containment structures. The completed form and <br /> printoutsfi-oin tests(if applicable),should be provided to the.favilitY ownerloperator./br sulnuittal to the local regulatoi-v agency. <br /> 1. FACILITY INFORMATION <br /> Facility Narne:United Pacific 5446 Date of Testing: 12/02017 <br /> Facility Address:1403 Country Club Blvd.,Stockton,CA 95201 <br /> Facility Contact:Site Manger 1'1,,,n,.(209)943-2082 <br /> Date Local Agency Was Notified of Testing:11/30,!2017 <br /> Name of Local Agency Inspector(if presentduring testing):Aaron Hang <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:Armour Petroleum Service and Equipment Corporation <br /> Technician Conducting Test:Daniel Armour <br /> Credentials': (E]CSLB Contractor E]ICC Set-vice Tech. []S CB Tank <br /> License Number(s):498721.8215807 <br /> 3, SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: <br /> Test Equipment Used:Paint Mark Equipment Resolution:Visual <br /> Identify Spill Bucket(By Tank I Waste Qil 2 3 4 <br /> Number,Stored Pro lucl,el,.) <br /> Direct Bury Direct Bury ®Direct Bury []Direct Bury <br /> Bucket Installation Type: Contained in Contained in P]Conlaincd in <br /> u []Contained in Sump <br /> um n, <br /> Purnp Sump 1p <br /> Bucket Diameter: 12" <br /> Bucket Depth: 12" <br /> Wait time between applying 5 Mill. <br /> vacuum/water and start of test: <br /> Test Start Time ffj1: 10:09am <br /> Initial Reading(Rj): paint mark <br /> Test End Time(TF): 11:1 oat" <br /> Final Reading(RF): @)paint mark <br /> Test Duration(TF—Tr): I hour <br /> Change in Reading(RF-Rj): 0 <br /> Pass/Fail Threshold or Criteria: No visual loss <br /> Test Result: E]Pass E]Fail E]Pass Fail ®Pass Fail E]Pass E]Fail <br /> COMMentS—(include information on repairs made prior to testing,and i-ecoiiinteiided.follovi,-ttl),Iitl-failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this reliart is true,accurate,and in fall contlyflance with legal requirements. <br /> Technician's Signature:-- Date: 121 1/2017 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor. Vlowever,local requirements <br /> may be more stringent. <br />