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SWRCB,January 2006 Spill Bucket Testing Report Form MAR 2 5 2016 This form is intended for use by contractors performing annual testing of UST spill containment structuress M A tbti printouts from tests(tf applicable)should be provided to the facility owner/operator for submittal to the lo4e�eg�ela �a I. FACILITY INFORMATION Facility Name: VALLEY PACIFIC CHARTER WAY I Date of Testing: 311112016 Facility Address: 1501 W CHARTER WAY,STOCKTON, CA 95206 Facility Contact: MIKE ELIASON Phone: (209)948-9412 Date Local Agency Was Notified of Testing: 2118116 Name of Local Agency Inspector(if present during testing): STACEY 2. TESTING CONTRACTOR INFORMATION Company Name: TANK-TEK ENVIRONMENTAL CORPORATION Technician Conducting Test: RICHARD THOMAS Credentials: ®CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑Other(Specify) License Number(s): 803705(CSLB Contractor)-5254736-UT(ICC Service Tech)-06-1672(SWRCB Tank Tester) 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ® Hydrostatic ❑Vacuum ❑Other(Spec) Test Equipment Used: VISUAL-TAPE MEASURE Equipment Resolution: 1/16" Identify Spill Bucket(By Tank Number,Stored Product, etc.) 87 FILL DIESEL FILL 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: 12" 12" Bucket Depth: 13.75" 13.25" Wait time between applying 10 MIN 10 MIN vacuum/water and start of test: Test Start Time(Ti): 8:40 8:40 Initial Reading(Rj): 12.25" 12.25" Test End Time(TF): 9:40 9:40 Final Reading(RF): 12.25" 12.25" Test Duration(TF-Ti): 1 HR 1 HR Change in Reading(RF-Rj): 0 0 Pass/Fail Threshold or Criteria: NO LOSS NO LOSS NO LOSS NO LOSS Test Result: 0 Pass ❑Fait 0 Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail Comments-(include information on repairs made prior to testing, and recommended follow-up for jailed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certyythat all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: Date: 311112016 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.