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RECEIVED Spill Bucket Testing Report Form AUG anuary 2006 I t�LTit This form is intended for use by contractors performing annual testing of UST spill containin 1 ' cab l��ed orm and printouts from tests(if applicable)should be provided to the facility owner/operator for submittal to t 1r1gNIk�`l�agency. 1. FACILITY INFORMATION Facility Name: United Pacific#5447 Date of Testing: 08/02/18 Facility Address: 1469 East Hammer Lane;Stockton,CA 95210 Facility Contact: Tom M. Robins I Phone: (310)323-3992 ext.#2012 Date Local Agency Was Notified of Testing: 07/30/18 via email Name of Local Agency Inspector(if present during testing): Aaron Hang @ San Joaquin E.H.D. 2. TESTING CONTRACTOR INFORMATION Company Name: CGRS,Inc. Technician Conducting Test: RICHARD THOMAS Credentials': ®CSLB Contractor ®ICC Service Tech. ®SWRCB Tank Tester ❑Other(Specify) License Number(s): 803616(CSLB Contractor) -- 5297888-UT(ICC Service Tech.) -- 06-1672(SWRCB Tank Tester) 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ®Hydrostatic ❑Vacuum ❑Other(Spec) Test Equipment Used:Tape Measure Equipment Resolution:+or—1/16" Identify Spill Bucket(By Tank T-1 91 Fill T-2 89 Fill T-3 87 Fill T-4 Diesel Fill Number, Stored Product, etc.) Bucket Installation Type: ®Direct Bury ®Direct Bury ®Direct Bury ®Direct Bury ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 151° 14" 14" 14'/1' Wait time between applying 10 min. 10 min. 10 min. 10 min. vacuum/water and start of test: Test Start Time(Ti): 9:12am 9:12am 9:12am 9:12am Initial Reading(Ri): 15" 14" 14" 14%" Test End Time(TF): 10:12am 10:12am 10:12am 10:12am Final Reading(RF): 12'/1' 14" 14" 14%" Test Duration(TF—Ti): 1 hour 1 hour 1 hour 1 hour Change in Reading(RF-Rj): .2'/4" 0.01° 0.0" 0.0" Pass/Fail Threshold or Criteria: No Loss No Loss No Loss No Loss Test Result: ❑ Pass 0 Fail ® Pass ❑Fail 10 'Pass ❑Fail ® Pass ❑Fail Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) 1. T-1 91 Fill bucket failed hydrostatic testing,leaks confirmed to be outer wall of spill bucket.OPW Cast Iron base direct bury style bucket installed.CUPA will require permit for replacement.Recommend OPW Double Wall Edge for replacement. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: Z==P Date: 08/02/18 ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.