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SWRCB,January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(if applicable)should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: SOUTH BAY TIRE I Date of Testing: JUNE 21,2007 Facility Address: 1501 W. CHARTER WAY, STOCKTON, CA 95206 Facility Contact: MIKE ELIASON I Phone: (209) 948-9412 Date Local Agency Was Notified of Testing: JUNE 14, 2007 Name of Local Agency Inspector(i(present during testing): WILL NG 2. TESTING CONTRACTOR INFORMATION Company Name: TANK-TEK ENVIRONMENTAL CORPORATION Technician Conducting Test: ROB NEIMEYER Credentials': ® CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Specify) License Number(s): 803705 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other(_peci,,) Test Equipment Used: Equipment Resolution: Identify Spill Bucket(By Tank 1 2 3 4 Number, Stored Product, etc.) REGULAR DIESEL Bucket Installation Type: ® Direct Bury ® Direct Bury ❑ Direct Bury ❑Direct Bury ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump Bucket Diameter: 10.50" 10.50" Bucket Depth: 12.00" 12.00" Wait time between applying 0 0 vacuum/water and start of test: Test Start Time(Ti): 9:00 AM 9:00 AM Initial Reading(Rj): 12.00" 12.00" Test End Time(TF): 9:30 AM 9:30 AM Final Reading(RF): 12.00" 12.00" Test Duration(TF—TI): 30 MIN 30 MIN Change in Reading(RF-RI): 0 0 Pass/Fail Threshold or Criteria: Test Result: ® Pass ❑Fail ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature:!__`— Date: JUNE 21,2007 ' State laws and regulations do not currently require testing to be performed by a qualified contr..ctor. However, local requirements may be more stringent.