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SWRCB. January 2006 <br />Spill Bucket Testing Report Form <br />7Eris fiirm i.y inzendedfor use by confrawars pelbrming towneul 1"jing qf UST spill conlainmew strucatres. The complefedform and <br />prinzattisfrom iests 0j'applicoblv, should he provided to fhefiaedir oitwer/operatorfur submitiul ro the fatal regidaton, agvncl-, <br />1. FACILITY WFORNIATION <br />Facility Name: U WTED PACIFIC V5446 Ea_i,_2 ;f Testing: 5! IA 7 <br />Facility Address: 1403 COUNTRY C BLVD--' STOCKTON. CA 95204 <br />Facility Contact: Phone. <br />bate Local Agency Was Notified ofTcsfing .4/19/17 <br />Name of Local Agency Inspector (if1preswit during reming): <br />STACY <br />Z. -1 ES -1-11N U CONTRAWFOR INFUltMATION <br />Company Name-, AFFORDA TEST 416T'EStreet Galt,CA95632 (209) 744-0112 Fax: (209) 744-0116 <br />Technician; gEd Stearns ❑ Zane A. Nimmo E] David A. WjnMer [] Felix G, Ramirez <br />5230492 -UT 5263322 -UT 5263373 -UT 52739344111' <br />Credentials': E ICC Service Tech. SW RCB Tank Tester <br />3. SPILL BUCKET TESTING INFOXVIATION <br />Test Method Used: Hydrostatic El Vacuum [:1 Other <br />Test Equipment Used: TAPE MEASURE <br />Equipment Resolution: 1116 <br />ldenti- Spill Bucket �Av 7`ank <br />1 87 <br />2 91 <br />3 I)SI, <br />4 <br />Number. SwredProduci, etcI <br />I <br />0 Direct Bu <br />Bury <br />Direct Bury <br />-0_ D 1, i <br />rc , ct Bury <br />0 Direct Burv. <br />Buc�-et Instillation Type: <br />D Contained in Sump <br />Contained in Sump <br />0 Contained in <br />El Contained ill <br />Sump <br />Bucket Diameter: <br />I <br />Bucket Depth: <br />12 <br />11 <br />12 <br />Wait time- between applying <br />vacuunn1watcr and start of tem-, <br />Test Start Time (TI): <br />1400 <br />1400 <br />1400 <br />- <br />Initial Reading (RI), <br />11 <br />10 <br />1500 <br />I I <br />1500 JU <br />Test End Tinic (TF): <br />1500 <br />Final Reading (R,); <br />F0 <br />11 <br />IHR <br />L. <br />Test Duration (Tr --tj): <br />IIFS, <br />I I I R <br />Chang <br />,c in Reading (Rr - Rj)_' <br />: a <br />0 <br />0 <br />�T <br />Pas&4all "fl—ires-hold or <br />crkcria: <br />1116 <br />L116 <br />1/16 <br />Test Result: <br />Pass DEarl <br />0 Pass El Fail <br />, N Pa! <br />El Pass El Fail <br />Coniracrits — Cine- tide in iLlMinz <br />CERTIFICATIONN.OF TECHNICIAN RESPONSIBLE H Olt (:ONI)tJ(:'I'IjNt;'I'EiIS'I'k:S'l-IN(; <br />I hereby ctutify that all the information contained in this rCpDrt is true, accurate, and in full compliance with legal requirements. <br />Technician's Siff41- <br />nature, <br />Date:5/1/17 <br />'State laws and regulations do not currently require lesting to be perfornied by a qualifted contractor. However, local requirements <br />may be more stringent. <br />