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*RECEIVED <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form APR 10 2018 <br /> This form is intended for use by contractors performing annual testing of UST spill containme r t , .HEALTH DE py <br /> ed form and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for subm agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: AFS SINCLAIR MINI MART Date of Testing: 03-28-18 <br /> Facility Address: 7906 N EL DORADO ST. STOCKTON,CA 95210 <br /> Facility Contact: PAUL Phone: 209-957-2987 <br /> Date Local Agency Was Notified of Testing:02-28-18 <br /> Name of Local Agency Inspector(if present during testing): SAN JAOQUIN CO <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 /> 8883080-UT 8883064-UT 8883059-UT 8883072-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: 1/16 <br /> a _ , � r h ,..t �. <br /> Identify Spill Bucket(By Tank 1 87 2 87 SYPON 3 87 SLAVE 491 <br /> Number, Stored Product, etc. <br /> E]Direct Bury F-1DirectBury <br /> Bucket Installation Type: El Direct Bury El Direct Bury ®Contained in ® Contained in <br /> ® Contained in Sump ®Contained in Sump Sump Sum <br /> Bucket Diameter: 11 11 11 11 <br /> Bucket Depth: 14 14 14 14 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 900 900 900 900 <br /> Initial Reading(RI): 13 13 13 13 <br /> Test End Time(TF): 1000 1000 1000 1000 <br /> Final Reading(RF): 13 13 13 13 <br /> Test Duration(TF—TI): 1 HOUR 1 HOUR 1 HOUR I HOUR <br /> Change in Reading(RF-R,): 0 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: ® Pass ❑Fail ® Pass ❑Fail 0 Pass ❑Fail ® Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW 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: Date:03-28-18 <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 />