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SWRCB,January 2006 <br /> SPILL BUCKET TESTING REPORT FORM <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printout from <br /> 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:AT&T Corporation Date of Testing:06/23/2008 <br /> Facility Address:J110 W.Tumer Rd. Lodi CA 95242 GEO PAR#CAK482 <br /> Facility Contact:CONNIE MITCHELL E.S.M. Facility Phone: <br /> Date Local Agency Was Notified of Testing:05/19/2008 <br /> Name of Local Agency Inspector if present during testing):SAN JOA UIN COUNTY HEALTH DEPARTMENT <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test:MICHAEL L.STRAWN II <br /> Credentials: ®CSLB Contractor ®ICC Service Tech ❑SWRCB Tank ❑Other(Specify) iNCON 755803761 <br /> Tester <br /> License Number (s):A ASB HAZB C-10. 588098:ICC 5262091-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum [-]Other <br /> Test Equipment Used:INCON TS-STS E ui ment Resolution:0.0006 <br /> Idents Spill Bucket(By Tank Number, 1#CAK482U001 2 3 4 <br /> Stored Product,etc) <br /> Bucket Installation Type ®Direct Bury ❑Direct Bury El Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter inches 11 INCHES <br /> Bucket Depth inches 12 INCHES <br /> Wait Time between applying 15 MINUTES <br /> vacuum/water and start of test <br /> Test Start Time: 11:16AM 11:33AM <br /> Initial Reading Ri): 6.3635 6.3625 <br /> Test End Time: 11:32AM 11:49AM <br /> Final Reading 6.3633 6.3618 <br /> Test Duration: 15 MIN. 15 MIN. <br /> Chan a in Reading Rf-Ri : -0.0002 -0.0007 <br /> Pass/Fail Threshold or Criteria: 0.002 <br /> Test Result Pass <br /> Comments:DIESEL FILL BUCKET#CAK482U001 PASSED THE REQUIRED HYDROSTATIC TEST.NO REPAIRS ARE <br /> NEEDED AT THE PRESENT TIME. <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 06/23/2008 <br />