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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 />Company Name: PETRO-TECHZ Environmental Services <br />Technician Conducting Test: Dan Zeman <br />Credentials': ❑ CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑ Other (Spec) <br />License Number(s): ICC Service Technician No.: 5243781 -UT — CA SWRCB Tank Tester License No.: 1535 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: Hydrostatic Vacuum Other: <br />Test Equipment Used: Lake Test I Equipment Resolution: Tape Measure <br />Identify Spill Bucket (By Tank 1 Unleaded <br />Number, Stored Product, etc. <br />Bucket Installation Type: Direct Bury <br />Bucket Diameter: 11" <br />Bucket Depth: 13" <br />Wait time between applying 15 Minutes <br />vacuum/water and start of test: <br />Test Start Time (TI): 2:04 pm <br />Initial Reading (Ri): 12 %2" <br />Test End Time (TF): 3:04 pm <br />Final Reading (RF): 12 1/2" <br />Test Duration (TF — TI): 60 Minutes <br />Change in Reading (RF - RI): 0.00 <br />Pass/Fail Threshold or p/4" in a 24 Hr. Period <br />Criteria: <br />Test Result: Pass <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />Test H20 was stored in an on site liquid waste drum. <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: June 7.2007 <br />