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P.O.Box 4208 <br /> Sonora CA 95370 <br /> 1jteChPe- tr-0 RE&IVED Ca:623541 A-Haz <br /> Phone:209-532-7320 <br /> Compliance without Compromise JUN <br /> 11 2014 Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> Spill Bucket Testing Repo www.alitechpetro.com <br /> 1. FACILITY INFORMATION <br /> Facility Name: Costo #1091 Lodi Date of Testing: 05/28/14 <br /> Facility Address: 2680 Reynolds Ranch Rd. <br /> Facility Contact: Rick Medeiros Phone: 209-366-7332 <br /> Date Local Agency Was Notified of Testing : 4/24/14 <br /> Name of Local Agency Inspector (if present during testing): Aris Cacapit <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Alltech Petro Inc, P.O. Box 4208, Sonora CA 95370. (209) 532-7320 <br /> Technician Conducting Test: Isaac Anderson <br /> Credentials ® CSLB Contractor ® ICC Service Tech. ® SWRCB Tank Tester ❑ Other (Specify) <br /> License Number(s): ICC UST Technician #8146912-UT SWRCB 09-1749 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: One Hour observed test Equipment Resolution: 1/16" <br /> Identify Spill Bucket (By 1 87A Vapor 2 87B Vapor 3 91 Vapor 4 Additive Aux <br /> Tank Number, Stored <br /> Product, etc.) <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® In Sump Z In Sump In Sump In Sum <br /> Wait time between <br /> applying vacuum/water 0 0 0 <br /> and start of test: <br /> Test Start Time(T,): 8:00 8:00 8:00 8:00 <br /> Initial Reading (R,): Top of cap Top of cap Top of cap Top of cap <br /> Test End Time(TF): 9:00 9:00 9:00 9:00 <br /> Final Reading (RF): Top of cap Top of cap Top of cap Top of cap <br /> Test Duration (TF—T): 1.0 hr 1.0 hr 1.0 hr 1.0 hr <br /> Change in Reading (RF-R,): 0.0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: Pass ❑ Fail I ® Pass ❑ Fail I ® Pass ❑ Fail Z Pass [] Fail <br /> Comments — (include information on repairs made prior to testing,and recommended follow-up for failed <br /> tests) <br /> 6 <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> l hereby certify that all the information contained in this report is true, accurate,and in full compliance with legal <br /> requirements. <br /> Technian: Date: 05-28-2014 <br />