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RECEIVED SWRCB,January 2006 <br /> OCT 2 3 2018 Spill Bucket Testing Report Form <br /> This form is intended or use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> ENV1R@%MfiD*a*ksMW1 'fHb1e),should be provided to the facility ownerloperatorfor submittal to the local regulatory agency. <br /> DEPARTMENT 1. FACILITY INFORMATION <br /> Facility Name: Frontier Manteca Date of Testing: 9-13-2018 <br /> Facility Address: 430 West Center St <br /> Facility Contact: Atinesh Chandra Phone: 209-456-9727 <br /> Date Local Agency Was Notified of Testing: 9-5-18 <br /> Name of Local Agency Inspector(ii(present during testing): None Present <br /> 2, TESTING CONTRACTOR INFORMATION <br /> Company Name: CALIFORNIA HAZARDOUS,INC. <br /> Technician Conducting Test: Raul Ochoa <br /> Credentials': jo CSLB Contractor Z ICC Service Tech. El SWRCB Tank Tester El Other(Specify) <br /> License Number(s):734854 ICC#:8029372 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: 0 Hydrostatic 0 vacuum El Other Visual(Specjo�)__ <br /> Test Equipment Used:Measuring Tape Equipment Resolution: 1/16" <br /> Test <br /> Spill Bucket Tank TI Diesel <br /> Number,Stored Product, etc. <br /> El Direct Bury n Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type: 0 Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> F1 On To of AST ❑On To of AST On To of AST On To of AST <br /> Bucket Diameter: 12" <br /> Bucket Depth: 14.75" <br /> Wait time between applying 15 Min <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 11:45am <br /> Initial Reading(111): 13.25" <br /> Test End Time(TF): 12:45prn <br /> Final Reading(RF): 13.25" <br /> Test Duration(TF—Ti): I Hour <br /> Change in Reading(RF-Rj): 0 <br /> Pass/Fail Threshold or Criteria: Any Visible Drop <br /> Test Result: [9 Pass El Fail El Pass El Fail El Pan El Fail ❑ Pass E]Fail <br /> Comments—(include information on repairs made prior to testing,and recommended follow-up for failed tests) <br /> Water was placed inside 5 gallon bucket and left on site for proper disposal. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the in!f7i ;atiVontalned in, is report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: Date 9-13-2018 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be <br /> more stringent. <br />