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04/12/2012 12:42 (209) 465-4933 Wayne Henderson Page 515 <br />SWRCB, January 2006 <br />Spill Bucket Testing Report Form <br />This form is intended for use by contractors performing annual testing of UST shill containment structures. The contpleted,fornt and <br />printouts frons tests (If applicable)..should be prorided to the facility owner.`operator for submi/tal to the local regulatory tagencj� <br />I_ FACITATV INFORMATION <br />Facility Name: <br />C[TY OF STOCKTON --CORP YARD Date of Testing: 3/10/10 <br />Facility Address: <br />1465 S. LCNCOLN S['. STOCKTON. CA 95206 <br />Facility Contact: <br />TERRY WILLIAMS Phone: <br />.Date Local Agency <br />Was Notified of Testing :3(=4/11. <br />Name of Local Agency Inspector (if present during testing): STACY <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: AFFO.RDA TEST 416 2"`' 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 />II Credentials': ® ICC Service'rech. ® SWRCB,rank"fester I <br />3. SPILL BUCKET TESTYNG INFORMATION <br />Test Nlethod Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: TAPE MEASURE, <br />1420 Equipment Resolution: 1/16" <br />Identify Spill Bucket (All Tank <br />Number, Storer/ Product, etc.) <br />1 87 <br />2 <br />3 <br />4 DI.ES.EI. <br />Bucket Installation Type: <br />® Direct Bury <br />E] Contained 'in Sump <br />❑ Direct Bury <br />C] Contained in Sump <br />C] Direct Bury <br />❑ Contained in <br />Sump <br />® Direct Bury <br />F] Contained in <br />Sump <br />Bucket Diameter: <br />1 ! <br />11 <br />Bucket Depth: <br />14 3/8 <br />16 314 <br />Wait time between applying <br />vacuunvwater and start of test: <br />Test Start Time (TT}: <br />1340 <br />1340 <br />Initial Reading (RT): <br />13 3/8 <br />15 3/4 <br />Test End Time (Th): <br />1440 <br />1440 <br />Final Reading (RF): <br />13 3/8 <br />15 314 <br />Test Duration (TT. - To: <br />HR <br />(IR <br />HR <br />FFR <br />Change in Reading (RF - Rr): <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />- <br />- <br />St ..... ....... <br />..... .. <br />Fait <br />Comments — (include information on repairs made prior to testing, and recommended,follow-tip,for ftriled tests) <br />CER`fIFICATION OF TECtINICIAIN RESPONSIBLE FOR CONDUCTINGTHIS 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: Date: <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 />