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RECEIVED <br /> SWRCB January 2006 <br /> Spill Bucket Testing Report Form J 1�' <br /> This form is intended for use by contractors performing annual testing of UST spill containment 4*rm and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for submitta to �r ES'agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: GRUPE AIR I Date of Testing: 12-15-17 <br /> Facility Address: 5000 S LINDBERGH ST STOCKTON CA <br /> Facility Contact: MAURICE Phone: <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing): cesar <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: ® David A.Winkler <br /> 5263373-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: H2O&TAPE MEASURE Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 JET FUEL 4 <br /> Number, Stored Product, etc. <br /> ®Direct Bury ❑Direct Bury <br /> Bucket Installation Type: ❑ Contained in <br /> ❑ Contained in Sump Sum <br /> Bucket Diameter: 11 <br /> Bucket Depth: 12.50 <br /> Wait time between applying NA NA <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 9 <br /> Initial Reading(RI): 12 <br /> Test End Time(TF): 10 <br /> Final Reading(RF): 12 <br /> Test Duration(TF—Tj): 1 HR <br /> Change in Reading(RF-Rj): 0 <br /> Pass/Fail Threshold or 1/16 <br /> Criteria: <br /> Test Result: ® Pass ❑Fail ❑ Pass ❑Fail ❑ 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 /> 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 />