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SWRCB,January 2006 <br /> 9. SIDI Bucket Testing Repor orm <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 /> 1. FACILITY INFORMATION <br /> Facility Name: CONOCO PHILLIPS #2705447 7 Date of Testing: 08/06/2007 <br /> Facility Address: 1469 E HAMMER LANE STOCKTON, CA, 95209 <br /> Facility Contact: MANAGER-TOM Phone: (2 0 9) 478-1522 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: DOUG FALDE <br /> Credentials I: ❑CSLB Contractor ❑ICC Service Tech. ❑SWRCB Tank Tester E Other(Spec) I CC <br /> License Number: 5307847-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: El Hydrostatic 0 Vacuum ❑ Other <br /> Test Equipment Used:TEST FLUID AND TAPE MEASURE Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 1 SUP FILL 2 1 SUP VAPOR 3 2 PLU FILL 4 2 PLU VAPOR <br /> Number, Stored Product, etc) <br /> ❑X Direct Bury X❑Direct Bury X❑Direct Bury ❑X Direct Bury <br /> Bucket Installation Type: <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 11.00 11.00 11.00 11.00 <br /> Bucket Depth: 15.00 13.75 14.00 14.75 <br /> Wait time between applying 5MIN 5MIN 5MIN 5MIN <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 1055 1215 1055 1215 <br /> Initial Reading(R i ): 12.50 11.00 11.50 11.50 <br /> Test End Time(TF ): 1155 1315 1155 1315 <br /> Final Reading(R F ): 12.50 11.00 11.50 11.50 <br /> Test Duration: 1HR 1HR 1HR 1HR <br /> Change in Reading(R F-RI ): 0.00 0.00 0.00 0.00 <br /> Pass/Fail Threshold or P P P P <br /> Criteria: <br /> MM <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: 08/06/2007 <br /> I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />