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Mar 05 10 10:18a Reliable PetroleumA <br />209-845-8953 p.3 <br />0 <br />SWRCB, January 2006 <br />This form is intended for use by contractors performing annual testing of UST SPI/l containment structures The completed form and <br />printouts from tests (if applicable), should be provided to the facility ownerioperator for submittal to the local reguWory agency. <br />1. FACILITY INFORMATION <br />Facility Name: WILSON WAY CHEVRON Date of Testing: 02-18-10 <br />Facility Address: 437 Ni. Wilson Way, Stockton CA 95205 <br />Facility Contact: Arran Mehroke I Phone: 209-942-2344 <br />Date Local Agency Was Notified of Testing. 02-09-10 <br />Name of Local Agency inspector (if present during testing): Staev Rivera <br />2. TESTING CONTRACTOR INFO 4,TION <br />Company Name: RELIABLE PETROLEUM SERVICES INC. <br />Technician Conducting Test: Robert Barnhart <br />Credentials': X CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) <br />License Number(s): 883706 5252540 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: X Hydrostatic C Vacuum ❑ Other <br />Test Equipment Used: Standard Tape Measure I Equipment Resolution: — <br />Identify Spill Bucket (By Wank <br />Number, Stored Product, etc. <br />Bucket Installation Type: <br />T1: Regular <br />0 Direct Bury <br />X Contained in Sump <br />T2: Supreme 3 <br />0 Direct Bury 0 Direct Bury <br />X Contained in Sump 11 Contained in <br />Bucket Diameter: <br />12" 12" <br />Bucket Depth: <br />15 yz" <br />133/4" <br />Wait time between applying <br />vacuum/water and start of test: <br />1min. <br />linin. <br />Test Start Time (TT): <br />11:08a.m <br />11:08a.m <br />Initial Reading (R5-): <br />14 %'1 <br />13'/<" <br />Test End Time (TF): <br />12:08p.m <br />12:08p -m <br />Final Reading (RF): <br />14 %" <br />13'/." <br />Test Duration (TF — TI): <br />1 hour <br />1 hoar <br />Change in Reading (RF - Rj): <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />1116' <br />1/I6" <br />E_ <br />❑ Direct Bury <br />0 Contained in <br />Test Result: <br />X Pass <br />❑ Fail <br />X Pass 0 Fail ❑ pass n FEAR n a 0 Fail <br />Comments(include mformatron <br />on repairs <br />made <br />prior to testing; and recommended follow up for failed tests) <br />CERTMCATION OF TECHNICIAN .RESPONSIBLE FOR CONDUCTING THIS TESTING <br />thereby certify that alt the information contained In this report is true, accurate, and In full compliance with legat requirements. <br />Technician's Signature; Date:02-18-10 <br />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 />