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RJOEIVED <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form JUL 2 4 2017 <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The com leted form and <br /> printouts from tests(f applicable), should be provided to the facility owner/operato agency. <br /> 1.FACILITY INFORMATION DEPARTMENT <br /> Facility Name: HAMMER LANE OIL Date of Testing: 06-12-17 <br /> Facility Address: 3304 HAMMER LANE STOCKTON CA 95209 <br /> Facility Contact: I Phone: <br /> Date Local Agency Was Notified of Testing:05-17-17 <br /> Name of Local Agency Inspector(zfpresent during testing): SAN JOAQUIN <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax: (209)744-0116 <br /> Technician Conducting Test: ❑Ed Stearns ❑ Zane A.Nimmo ❑ David A.Winkler ® Felix G. Ramirez <br /> 8184188 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑vacuum ❑ Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1/1.6 <br /> "777,77UTANW-UMk..e f< <br /> Identify Spill Bucket(By Tank 1 87 2 91 3 DIESEL 4 <br /> Number, Stored Product, etc. <br /> Direct B ®Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ® ®Direct Bury ❑Contained in El Contained in <br /> El Contained in Sump ❑Contained in Sump Sump Sum <br /> Bucket Diameter: 11 11 11 <br /> Bucket Depth: 13 13 13 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 1300 1300 1300 <br /> Initial Reading(Ri): 12 12 12 <br /> Test End Time(TF): 1400 1400 1400 <br /> Final Reading(RF): 12 12 12 <br /> Test Duration(TF—TI): 1 HOUR 1 HOUR 1 HOUR <br /> Change in Reading(RF-Rj): 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result. ® Pass ❑Fail ® 'Pass ❑Fail 0 Pass ❑Fail ❑ Pass El Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> ®PW BUCKETS <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: V Date:06-12-17 <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 />