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ROCEIVEDx-R <br /> CB,January 2006 <br /> Spill Bucket Testing Report For Y012014 <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 (f applicable), should be provided to the facility owner/operat I nl t egulatory agency. <br /> 1.FACILITY INFORMATION PERMIT/SERVICES <br /> Facility Name: CITY OF STOCKTON CORP YARD Date of Testing: 4-16-14 <br /> Facility Address: 1465S LINCOLN ST STOCKTON CA <br /> Facility Contact: Maria Phone: 937-8060 <br /> Date Local Agency Was Notified of Testing A-11-14 <br /> Name of Local Agency Inspector(f present during testing): ARIS <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 d Street Galt,CA 95632 (209)744-0112 Fax: (209)744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo ❑ Zane A.Nimmo ® David A.Winkler ❑ Felix G. Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-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 /> r <br /> Identify Spill Bucket(By Tank 1 87 2 3 DSL 4 <br /> Number, Stored Product, etc.) <br /> ® Direct Bury ❑Direct Bury ® Direct Bury ❑Direct Bury <br /> Bucket Installation Type: [—] Contained in ❑ Contained in <br /> ❑Contained in Sump ❑Contained in Sump 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(TI): 9 9 <br /> Initial Reading(RI): 14 16 <br /> Test End Time(TF): 10 10 <br /> Final Reading(RF): 14 16 <br /> Test Duration(TF—TI): IHR IHR <br /> Change in Reading(RF-RI): 0 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result. ® Pass ❑Fail ❑ Pass ❑Fail Z Pass ❑Fail ❑ Pass ❑Fail <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 /> TTechnician's Signature: Date 4-16-14 <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 />