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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed fonn and <br /> printouts from tests(if applicable),should be provided to the facility ownerloperator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Kaiser Stockton Date of Testing: 6/28/2017 <br /> Facility Address: 7373 West Lane <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: 6/28/2017 <br /> Name of Local Agency Inspector(if present during testing): Ei E <br /> 2. TESTING CONTRACTOR INFORMATION E <br /> Company Name: Beishire Environmental Services,Inc. <br /> Technician Conducting Test: David Walker <br /> Credentialst: ®CSLB Contractor ❑ICC Service Tech. ❑SWRCB Tank Tester ❑Other(SpecifyJ. s' <br /> License Number(s): 808313 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®H drostatic ❑Vacuum ❑ Other <br /> Test Equipment Used: Visual Equipment Resolution: ±1.00 <br /> Identify Spill Bucket(By Tank 1 DSL Fill 2 3 4 <br /> Number,Stored Product,etc.) <br /> Bucket.Installation Type: Direct Bury <br /> Bucket Diameter: 14" <br /> Bucket Depth: 12" <br /> Wait time between applying <br /> vacuum/water and start of test: 5 Minutes <br /> Test Start Time(TI): 11:50 AM <br /> Initial Reading(RD: 1.5"From Top <br /> i <br /> Test End Time(TF): 12:50 PM <br /> Final Reading(RF): 1.5"From Top <br /> Test Duration(TF—T): 1 Hour <br /> Change in Reading(RF-RD: 0 <br /> Pass/Fail Threshold or No Leaks <br /> Criteria' <br /> Test Resullt: ®Pass �Fail <br /> ❑Pass D Fail. Pass :CQ Fail Q raw,:.❑ Fail `' <br /> Comments—(include information on repairs madeprior to testing,and recommended follow-up for failed tests) <br /> Bucket leaked at cap. Replaced bad cap and re-tested bucket. After Re-test bucket is still leaking a small amount. Cleaned drain and re-tested for <br /> bucket to pass. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature:, .� Date: 6/28/2017 <br /> t 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 />