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6 <br /> ECEtED <br /> RCB,January 2006 <br /> Spill Bucket Testing Report Form JUL 10 ?-M <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/operator for submit ` ( W"tory agency. <br /> 1. FACILITY INFORMATION <br /> nFPARTM <br /> Facility Name: CITY OF STOCKTON CORP YARDDate of Testing: 4-23-18 <br /> Facility Address: 1465 S LINCOLN ST. STOCKTON,CA 95206 <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(f present during testing): BETTY <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑Ed Stearns ❑ Zane A.Nimmo ® David A.Winkler ❑ Felix G.Ramirez <br /> 8883080-UT 8883064-UT 8883059-UT 8883072-UT <br /> Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑ Other <br /> Test Equipment Used: h20 and tape measure Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 1 87 3 DSL <br /> Number, Stored Product, etc. <br /> ®Direct Bury ®Direct Bury <br /> Bucket Installation Type: El Contained in <br /> ❑ Contained in Sump Sum <br /> Bucket Diameter: 11 11 <br /> Bucket Depth. 15 17 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 1 1 <br /> Initial Reading(Rj): 14 16 <br /> Test End Time(TF): 2 2 <br /> Final Reading(RF): 14 16 <br /> Test Duration(TF—Tj): IHR IHR <br /> Change in Reading(RF-Rj): 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 <br /> Criteria: <br /> Test Result: PASS'' PASS <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <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 /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />