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0 <br />SWRCB, January 2006 <br />1 i Ott ;1' <br />This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />Facility Name: Hammer Lane Oil Inc. Date of Testing: 06-24-10 <br />Facility Address: 3304 W. Hammer Lane <br />Facility Contact: Mike Gurm Phone: 209-992-1415 <br />Date Local Agency Was Notified of Testing: 06/15/10 <br />Name of Local Agency Inspector (ifpresent during testing): Garrett Backus <br />Company Name: Reliable Petroleum Services Inc. <br />Technician Conducting Test: Guadalupe Sanchez <br />Credentialsi: X CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Specify) <br />License Number(s): 883706 5250451 -UT <br />Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Standard Tape Measure Equipment Resolution: <br />-77 <br />Identify Spill Bucket (By Tank Tl: 87 T2: 91 T3: Diesel <br />Number, Stored Product, etc. FILL FILL FILL <br />Bucket Installation Type: <br />X Direct Bury <br />❑ Contained in Sum <br />X Direct Bury X Direct Bury <br />❑ Contained in Sum ❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />1299 <br />12" 1299 <br />Bucket Depth: <br />12'/91 <br />12'/499 12Y2" <br />Wait time between applying <br />vacuum/water and start of test: <br />lmin <br />lmin lmin <br />Test Start Time (TI): <br />9:30a.m. <br />10:30a.. 9:32a.m. <br />Initial Reading (R,): <br />119' <br />113/8" 11'/4" <br />Test End Time (TF): <br />10:30a.m. <br />11:30a.m. 9:35a.m. <br />Final Reading (RF): <br />11" <br />113/8" 1199 <br />Test Duration (TF— TI): <br />lhr <br />lhr 3min <br />Change in Reading (RF- RI): <br />0 <br />0 1/491 <br />Pass/Fail Threshold or <br />Criteria: <br />1/16" <br />1/1699 1/169' <br />Test Result. <br />X Pass ❑ Fail <br />X Pass ❑ Fail ❑ Pass X Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing and recommended follow-up for failed tests) <br />Diesel fill box failed test — spill bucket needs to be replaced <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:06-24-10 <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 />