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0 <br />SWRCB, January 2006 <br />Spill Bucket Testing Report Form <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 submittal to the local regulatory agency. <br />1 7. A i"TT TTV TNIMIDM A'TlrnlV <br />Facility Name: City of Stockton, Corporation Yard Date of Testing: March 11, 2010 <br />Facility Address: 1465 S. Lincoln Street, Stockton, CA 95206 <br />Facility Contact: Terri Williams <br />Phone: 209-937-7416 <br />Date Local Agency Was Notified of Testing: February 23, 2010 <br />Name of Local Agency Inspector (fpresent during testing): <br />7_ TESTING CONTRACTOR INFORMATION <br />z cpTT T RTTd"WV T 'TF C'TTN(_' 1MMUM A TION <br />Test Method Used: x Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Equipment Resolution: <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc) <br />1 TANK #1 <br />DIESEL <br />2 <br />UNLEADED <br />TANK #1 <br />DIESEL RE -TEST <br />4 <br />Bucket Installation Type: <br />X Direct Bury <br />❑ Contained in Sump <br />X Direct Bury <br />❑ Contained in Sump <br />X Direct Bury <br />❑ Contained in Sump <br />❑ Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />12 inch <br />12 inch <br />12 inch <br />Bucket Depth: <br />17 inch <br />14-1/2 inch <br />17 inch <br />Wait time between applying <br />vacuum/water and start of test: <br />1 minute <br />1 minute <br />1 minute <br />Test Start Time (Ti): <br />9:26 a.m. <br />9:26 a.m. <br />10:09 a.m. <br />Initial Reading (Rj): <br />1-1/4 inch <br />1-1/4 inch <br />1-1/4 inch <br />Test End Time (TF): <br />ENDED TEST <br />10:26 a.m. <br />11:13 a.m. <br />Final Reading (RF): <br />EARLY BUCKET FAIL <br />1-1/4 inch <br />1-1/4 inch <br />Test Duration (TF — TI): <br />1 Hour <br />1 Hour <br />1 hour <br />Change in Reading (RF - RI): <br />-0- <br />-0- <br />Pass/Fail Threshold or <br />Criteria: <br />Less than 1/16 drop - <br />- 1/16 inch or less <br />1/16 inc-h or less <br />Test Result: <br />Pass X Fail <br />X Pass ❑ Fail <br />X Pass 0 Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for jailed tests) <br />DIESEL TANK #1 REPLACED GASKET ON FILL ADAPTER. <br />RE -TESTED. FILL BUCKET NOW PASSING <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: etc0114—td Date: March 11, 2010 <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 />