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*ill Bucket Testing Report Form 0 <br /> 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/operatorforsubmittal to the local regulatory agency. <br /> FACILITY INFORMATION Facility ID: UE046 <br /> Facility Name: Pacific Bell Telephone Co. dba AT&T California Date of Testing:3/14/2014 <br /> Facility Address: 907 LINCOLN RD., Stockton,CA 95207 <br /> Facility Contact: Dave Dube Phone: 209-598-5155 DEM /ED <br /> Date Local Agency Was Notified of Testing. 2014-02-25 <br /> Name of Local Agency Inspector(if present during testing): Jeff Wong 1040 0 <br /> 114 <br /> TESTING CONTRACTOR INFORMATION 1=11110inhilla �� � <br /> Company Name: TAIT Environmental Services,Inc. 5-3 low 11 awl INIVIIHEALTH DEPAFTSENT <br /> Technician Conducting Test: Dan Luck <br /> Credential i : CSLB Contractor r ICC Service Tech. SWRCB Tank Tester f Other(Specify) <br /> License number(s): A B ASB C-10 HAZ License Number 588098 : 5252167-UT <br /> SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: F Hydrostatic Vacuum F Other <br /> Test Equipment Used: Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 UE046U002 <br /> Number,Stored Product,etc.) <br /> Bucket Installation Type: Direct Bury f— Direct Bury F Direct Bury Direct Bury <br /> f7 Contained in Sump Contained in Sump F Contained in Sump Contained in Sump <br /> On top of AST On top of AST f On top of AST On top of AST <br /> Bucket Diameter: 11" <br /> Bucket Depth: 14 3/4" <br /> Wait time between applying <br /> vacuum/water and start of test: 15min <br /> Test Start Time(TI): 9:19am <br /> Initial Reading(RI): 14 1/4" <br /> Test End Time(TF): 10:19am <br /> Final Reading(RF): 14 1/4" <br /> Test D uration(TF—TI): 1 hour <br /> Change in Reading(RF-RI): 0 <br /> Pass/Fail Threshold or 0 <br /> Criteria: <br /> Test Result: Pass F Fail f Pass F Fail f� Pass Fail f Pass I— Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test water returned to TAIT shop. <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: At 10 Date: 3/14/2014 <br />