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11 <br />SWRCB, January 2006 <br />SPELL BUCKET TESTING REPORT FORM <br />This form is intended for use by contractors performing annual resting of UST spill containment structures. The completed form and printout from <br />tests (if applicable), should be provided to the facility owmerloperatorfor submittal to the local regulatory agency. <br />I. FACILITY INFORMATION <br />Facility Name: Pacific Bell Telephone Co. dba AT&T California Date of Testingg: 07/27/2009 <br />Facility Address. 907 LINCOLN RD., STOCKTON, CA 95207 GEO PAR # UE046 <br />Facility Contact: Connie Mitchell Facili!y Phone: <br />Date Local Agepcy Was Notified of Testing: 07/23/2009 <br />Name of Local AgeM 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: NCSLB Contractor ®ICC Service Tech OSWRCB Tank ElOther (Specify) <br />Tester <br />License Ntunber(s): A ASB HAZB C-10; 588098,5252163 -UT <br />3. SPELL BUCKET TESTING INFORMATION <br />Test Method Used — ®Hydrostatic Ovacuum E10ther <br />Test Equipment Used: Visual Measure Eauivment Resolution: 1/16" <br />Identory Split Bucket (By Tank Number, <br />Stored Product, etc) <br />1 UE046UO02 <br />2 <br />3 <br />'4 <br />Bucket Installation Type <br />E]DirW Bury <br />®Contained in Sump <br />00n to of AST <br />ElDirect Bury <br />®Contained in Sump <br />Ejon to of AST <br />r <br />ElDirect Bury <br />ElContained in Sump <br />00n Lop of AST <br />ElDirect Bury <br />ElContained in Sump <br />QOn to of AST <br />Bucket Diameter inches <br />IV <br />Bucket Depth (inches) <br />15 1/2" <br />Wait Time between applying <br />vacuum/water and start of test <br />15min <br />Test Start Time: <br />9:31 am <br />Initial Reading (Ri): <br />13 3/4" <br />Test End Time: <br />10:31 am <br />Final Reading (Rf): <br />13 3/4" <br />Test Duration: <br />I hour <br />Chane in Re ding _(_Rf - Ri): 110 <br />f <br />Pass/Fail Threshold or Criteria: <br />0 <br />Test Result 111pass <br />All test water was retained in approved containers labeled non haz and transported to Tait's 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 <br />�---f � Date 07/27/2009 <br />