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SWRCB, January 2006 <br />SPILL BUCKET TESTING REPORT FORM <br />T his 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/operatorfor submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: Pacific Bell Telephone Co. dba AT&T California Date of Testing: 05/06/2010 <br />Facili Address: 907 LINCOLN RD. STOCKTON CA 95207 GEO PAR # UE046 <br />Facility Contact: Connie Mitchell Facility Phone: 209-598-5155 <br />Date Local AgDcy AgencyWas Notified of Testing: 03/23/2010 <br />Name of Local Agency Inspector if present during testing): Garrett Backus <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TAIT ENVIRONMENTAL SERVICES <br />Technician Conducting Test: John Cascio <br />Credentials: ®CSLB Contractor ®ICC Service Tech ❑SWRCB Tank ❑Other (Specify) <br />Tester <br />License Numbers : A ASB HAZB C-10. 588098; 5252163 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br />(Test Equipment Used: Visual Measure lEquipment Resolution: 1/16" <br />Idento Spill Bucket (By Tank Number, 1 UE046UO02 2 3 4 <br />Stored Product, etc) <br />Bucket Installation Type <br />❑Direct Bury <br />®Contained in Sump <br />❑On top of AST <br />❑Direct Bury <br />❑Contained in Sump <br />Elon top of AST <br />El Direct Bury <br />❑Contained in Sump <br />❑On t2p of AST <br />❑Direct Bury <br />F-1 Contained in Sump <br />❑On t2p of AST <br />Bucket Diameter inches <br />lilt <br />Bucket Depth inches <br />151/4" <br />Wait Time between applying <br />vacuum/water and start of test <br />15 MIN <br />Test Start Time: <br />9:01 AM <br />Initial Reading i : <br />13 3/4" <br />Test End Time: <br />10:01 AM <br />Final Reading <br />13 3/4" <br />Test Duration: <br />1 HOUR <br />Chane in Reading f - Ri : <br />0 <br />Pass/Fail Threshold or Criteria: <br />0 <br />Test Result <br />Pass <br />Comments: All test water was retained in approved containers labeled NON HAZ, and transported to Tait. <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 C� Date 05/06/2010 <br />