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ill Bucket Testing Report Form <br />This form is intendedfor 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 INFORMATION Facility ID: UE231 <br />Facility Name: AT&T Corporation Date of Testing: 5/9/2012 <br />Facility Address: 110 W TURNER RD, LODI, CA 95242 <br />Facility Contact: Connie Mitchell <br />Phone: (209) 474-4022 <br />Date Local Agency Was Notified of Testing. 4/11/2012 <br />Name of Local Agency Inspector (if present during testing): Aris Cacapit <br />TESTING CONTRACTOR INFORMATION <br />Company Name: TAIT Environmental Services, Inc. <br />Technician Conducting Test: Victor Guerrero <br />Credential' : CSLB Contractor P ICC Service Tech r SWRCB Tank Tester r Other (Specify) <br />License number(s): A B ASB C-10 HAZ License Number 588098 : 8017001 -UT <br />SPILL BUCKET TESTING INFORMATION <br />Test Method Used: '' Hydrostatic f— Vacuum F Other <br />Test Equipment Used: INCON TS -STS <br />Equipment Resolution: .0006 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product,etc. <br />1 UE231U001 <br />Bucket Installation Type: <br />r Direct Bury <br />Contained in Sump <br />On top of AST <br />Direct Bury FDirect Bury <br />Contained in Sump f— Contained in Sump <br />On top of AST On top of AST <br />f— Direct Bury <br />I— Contained in Sump <br />On top of AST <br />Bucket Diameter: <br />11" <br />Bucket Depth: <br />12 1/4" <br />Wait time between applying <br />vacuum/water and start of test: <br />15 min. <br />Test Start Time (Tt): <br />10:11 am / 10:27 am <br />Initial Reading (Rt): <br />2.5396 / 2.5416 <br />Test End Time (TF): <br />10:26 am / 10:42 am <br />Final Reading (RF): <br />2.5416 / 2.5431 <br />Test Duration (TF —Tt): <br />15 min. <br />Change in Reading (RF -RI): <br />.002/.0015 <br />Pass/Fail Threshold or <br />Criteria: <br />,002 <br />Test Result: <br />1—v Pass F Fail <br />F Pass Fail r Pass r Fail <br />I— Pass r Fail <br />Comments —(include information on repairs made prior to testing, and recommendedfollow-up for failed tests) <br />All test water was taken tack to Tait's stop. <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: 5/9/2012 <br />