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SWRCB,Janumy 2006 <br /> Spill Bucket Testing Report Form <br /> This fofmtslnt&7dedfor&wbywntfaaorspe-fotmifUafm7LialtesUngofUSTsgllconteihnmtstaxiules. 777e compleWfolm andpnotouts from <br /> tests(if applicable),should be p1vv1ded to the fadlity r! for for subaziffal to the lbw1,ragt&tajy agency <br /> 1. FACILITY INFORMATION <br /> Facility Name: Wil—son Way Chevron ---T D;;of Testing: 11/16/06 <br /> Facility Mdrens: 437 N.Wilson Way,Stockton CA 95205 <br /> Facility Contact Owner/Mgr Phone: (209)942-2344 <br /> Name of Local Agency Inspector(ffpreswtduAhg tesfingJ Tua <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Compliance Solutions, Inc. <br /> Technician Conducting Test: Kevin R.Matlock <br /> Credentials': 0 CSLB Contractor 21 ICC Service Tech. SWRCB Tank Tester 0Other(Specify) <br /> License Num s): ICC#5069874-UT SB#02-1633 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: [j4Hydrostatic Elva um Mother <br /> Test Equipment Used: Tape Measure Equipment Resolution: 1/16® <br /> Identify Spill Bucket(By Tank Unleaded Premium <br /> Number,Stored Product, etc.L <br /> Bucket Installation Type: Sump Sump <br /> Direct Bu lSum�.. <br /> Bucket Diameter: 12" 12" <br /> Bucket Depth: 13" 13" <br /> Wait time between applying 5 in 5 in <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 0947 0947 <br /> Initial Reading(Rj): 63/4" 6%" <br /> Test End Time(TF): 1047 1047 <br /> Final Reading(RF): 63/4" 6%" <br /> Test Duration(TF-Tj): 1 hour 1 hour <br /> Change in Reading(RF-Rj): 1 0 0 <br /> Pass/Fail Threshold or Criteria: No Loss No Loss <br /> Test Result: Pass/Fail PASS PASS <br /> Comments-LneLuaL?#*nnawn on Mwfs made pwr to testng,and rewnwwded fao*,up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> hereby at of/the info mmhon contgwed in this Mport is fte,accufate,and in full wn7pliance with legal requirements. <br /> Technician's Signature: Date: 11/16/06 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more <br />