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RECEIVED <br /> ry 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment stru <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for submittal to the ocal reguatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: CITY OF STOCKTON CORP YARD Date of Testing: 4-14-2015 <br /> Facility Address: 1465 S LINCOLN ST STOCKTON CA <br /> Facility Contact: I Phone: <br /> Date Local Agency Was Notified of Testing A-10-15 <br /> Name of Local Agency Inspector(f present during testing): stacy <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 nd 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 /> Identify Spill Bucket(By Tank 1 87 2 3 DSL 4 dsI retest <br /> Number, Stored Product, etc.) <br /> ®Direct Bury ❑Direct Bury Direct Bury Direct Bury <br /> Bucket Installation Type: <br /> ❑ Contained in Sump ❑ El Contained in E]Contained in <br /> Contained in Sump Sump Sum <br /> Bucket Diameter: 11 11 I I <br /> Bucket Depth: 15 17 17 <br /> Wait time between applying - -- _ <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 120 120 2 <br /> Initial Reading(Ri): 14 16 17 <br /> Test End Time(TF): 220 220 3 <br /> Final Reading(RF): 13.50 12 15 17 <br /> Test Duration(TF—Tj): IHR IHR IHR 1 hr <br /> Change in Reading(RF-Rj): 0 0 0 0 <br /> Pass/Fail Threshold or 11/16 1/16 1/16 1/16 <br /> Criteria: <br /> Test Result: INCOMPLETE I ❑ Pass ❑Fail I Z Pass ❑Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> AFTER CHANGING DSL GASKET ON FILL ADAPTER BUCKETS PASSED <br /> 87 BUCKET INCOMPLETE RAN OUT OF TIME TO RETEST AFTER <br /> CHANGING FILL ADAPTER . HMC WILL RETEST BUCKET TOMORROW <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: """w" Date 4-14-15 <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 />