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. y <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report For <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed farm and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Gas Depot 2 1 Date of Testing: 12/10/07 <br /> Facility Address: 1330 E.Yosemite Ave.Manteca Ca.95336 <br /> Facility Contact: Seung Yong Hur Phone: (209)825-0332 <br /> Date Local Agency Was Notified of Testing: 12/06/07 <br /> Name of Local Agency Inspector(f present during testing): Muni Naidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Reliable Petroleum Services,Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': Di CSLB Contractor N ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 883706 5250451 -UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: [(Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: <br /> .. <br /> Identify Spill Bucket(By Tank 1 Tl—Regular 2 Tl—Premium 3 TI—Diesel 4 <br /> Number,Stored Product, etc.) Fill Fill Fill <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> Contained in Sump ®'Contained in Sump WContained in SlImp ❑Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 1.4" 131/4" 13'/2" <br /> Wait time between applying 2 min 2 min 2 min <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 2:18 PM 2:20 P.M 2:22P.M <br /> Initial Reading(RI): 9'/4" 9'/4" 12 1/8" <br /> Test End Time(TF): 3:38 P.M 3:39 P.M 3:40 P.M <br /> Final Reading(RF): 9'/4" 9'/4" 12 1/8" <br /> Test Duration(TF—TI): 1hr 21 min 1hr 19min lhr 18min <br /> Change in Reading(RF-RI): 0 0 0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" <br /> Criteria: <br /> TestResult: Pass ❑Fail 18' Pass ❑Fail R Pass ❑Fail ❑ Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <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: 12/10/07 <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 />