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SWRCB, January 2006 <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: CONOCO PHILLIPS #2705447 <br />DateofTesting: 08/26/2008 <br />Facility Address: 1469 E HAMMER LANE STOCKTON, CA, 95209 <br />Facility Contact: MANAGER - TOM <br />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 />CONTRACTOR2. TESTING INFORMATION <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: BRIAN MCPHEELY <br />Credentials) : <br />❑ Other <br />CSLB Contractor ❑ICC Service Tech. <br />❑ <br />SWRCB Tank Tester <br />❑ <br />Other (Spec) <br />License Number: <br />Test Method Used: <br />El Hydrostatic <br />❑ Vacuum <br />❑ Other <br />Test Equipment Used: WATER <br />Equipment Resolution: <br />Identify Spill Bucket(By Tank <br />I 1 SUP FILL <br />2 1 SUP VAPOR <br />3 2 PLU FILL <br />4 2 PLU VAPOR <br />Number, Stored Product, etc) <br />❑X Direct Bury <br />X❑ Direct Bury <br />X❑ Direct Bury <br />® Direct Bury <br />Bucket Installation Type: <br />❑ Contained in Sump <br />❑ Contained in Sump <br />❑ Contained in Sump <br />❑ Contained in Sump <br />Bucket Diameter: <br />12 <br />12 <br />12 <br />12 <br />Bucket Depth: <br />15 <br />14 1/2 <br />14 1/2 <br />14 1/2 <br />Wait time between applying <br />5MIN <br />5MIN <br />5MIN <br />5MIN <br />vacuum/water and starting test: <br />Test Start Time (TI ): <br />9: 2 0 <br />9: 2 0 <br />9:20 <br />9: 2 0 <br />Initial Reading (R I ): <br />14 1/4 <br />13 1/2 <br />13 <br />13 3/4 <br />Test End Time (TF ): <br />10 :2 0 <br />10 :2 0 <br />10 :2 0 <br />10 :2 0 <br />Final Reading (RF ): <br />14 1/4 <br />13 1/2 <br />13 <br />13 3/4 <br />Test Duration: <br />6 0MIN <br />6 OMIN <br />6 0MIN <br />6 0MIN <br />Change in Reading (R F - RI ): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />NO VISUAL <br />NO VISUAL <br />NO VISUAL <br />NO VISUAL <br />Criteria: <br />EMEMM <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: z �'�"� Date: <br />08/26/2008 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />