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APR-30-2010 FRI 05: 42 PM P. 039 <br /> 04/29/2010 09;56 20994339 APEC PAGE 03/03 <br /> sw=,January 2006 <br /> Spill Bucket Te' stiAg Repoit Form <br /> pedopnin,&WUal testing of UV Spill COkUa&MMW$&WC1We$. the com&tedfarm and <br /> rhisform is intended for use by contramm r <br /> prbro,,&jrom tests(#rapplicable),should be provided 10 thef=&O,Oww�rOperagorforjubmaYal to the local regWOO y maw, <br /> I. FACnmO TION--- <br /> I Date of Tgsj!�&: 4-12-10 <br /> Fa6lity Nam: TRACY TRUCK.STOP <br /> CA 95376 <br /> Facility <br /> Address: 3940 X�TRACY 5LVj%.TRA <br /> EFavoitti"W Contact-- DEBOM �pbow. (209)832-5,OW <br /> L r L�( i�lo m <br /> Xto Local Apvgy Was No flied <br /> N arm c. testingk, TRACYRIVERA <br /> arise of Local AgamY Inspector(fpr'4m9ntt!=1 <br /> ,�.TION <br /> 2. USTING CONTRACTOR WORMA11214 <br /> Corti y Name SS-,r.S6pvjCE STATION TESTING <br /> Tec haidmCondg:%ivs Test HEATH MCEVER <br /> Cmj"tW$,. a Odw r-Wecify) <br /> . a CSL9 Contmctor 0 ICC ice Teat- X SWRCS Tank Tomw <br /> Liccnge <br /> 14umbet(s): 04-1677 <br /> 3�, Spnj�)%UCXET TIZSTING INFORMATION <br /> Test M*tW Used., x Hydromic a vaco= M Oihm <br /> Test.E,16pmen%Used:WATER I I Bquipinent-Rcsob;Cm. INCHES <br /> "'MEWnw, 3 1 <br /> Id"tj*Spill lBucket,(By-rank 187 2 4 <br /> Nzunbff.&ored pro4et etc.) <br /> JLDhvd BAWY aDasaOury M Dire=Hurt' <br /> bucketinftlluwn Type, C3 CanWned in Sucre13 Corodnedin Sumr.CominW 'i Cagained in Su <br /> e <br /> Bucimt Diavftter. 1 11 1 <br /> —T <br /> Suoka Depth: 13.5 <br /> Veit 4me bthvwn applying <br /> vactaungwam and statt of WU: <br /> 1317 <br /> 12.5 <br /> Tat End Time(T(r), 1417. <br /> Fihal Reaft(Rf. 12-5 <br /> Test Duration(TV—Tt): <br /> Q4V in ReadW2(R,--F-1) : 0 <br /> PuVftii Thre0old or 0 <br /> cogameats—Anclude iSeMatwn an repair,made prior tot and mcOmmend1d2oM—Q=-'E <br /> CERTMCATION OF TECOMOAM-RESPONSm- E FoR CONIDUC"NG THISTEM. NG <br /> I horby cerftfy that#11 the Informai rainedin this ro4velfs true,dc*vmte,and ifift"OnObbed w"legal requkemom <br /> Technician's Signatuft: <br /> I State laws 4W mpladm do tint cmently require tinting to be peff=ked by a qmfflied wuMclor.However,10ml TKMMtM <br /> mcm ho yfworo +V;nOWO t <br />