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CB, January 2006 <br />Spill Bucket Testing Report Form <br />This form is intended for use by contractors performing annual testing of UST spill co 4 0_4�e rm and <br />printouts from tests (f applicable), should be provided to the facility owner/operator for submit�.Qyl to latory agency. <br />1_ FACILITV INFORMATION <br />Facility Name: SAN JOAQUIN MOTORPOOL Date of Testing: 7-24-2017 <br />Facility Address: 121 SAN JOAQUIN ST STOCKTON CA 95202 <br />Facility Contact: ROBERT Phone: 209-468-2068 <br />Date Local Agency Was Notified of Testing :6-29-17 <br />Name of Local Agency Inspector (f present during testing): AARON <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: AFFORDA TEST 416 2"d Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 <br />Technician Conducting Test: ❑ Ed Stearns ❑ Zane A. Nimmo ® David A. Winkler ❑ Felix G. Ramirez <br />8184188 5263322 -UT 5263373 -UT 5273934 -UT <br />Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />® Hydrostatic <br />❑ Vacuum <br />❑ Other <br />Test Equipment Used: TAPE / <br />14 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />Bucket Installation Type: <br />H2O <br />1 87 <br />® Direct Bury <br />❑Contained in Sump <br />EEEEMMEEWEWEWMEEM� <br />2 <br />El Direct Bury <br />❑Contained in Sump <br />Equipment Resolution: <br />3 <br />E] Direct Bury <br />El Contained in <br />Sump <br />1/16 <br />4 <br />El Direct Bury <br />F-1 Contained in <br />Sum <br />Bucket Diameter: <br />17 <br />Bucket Depth: <br />22 <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (Ti): <br />145 <br />Initial Reading (RI): <br />21 <br />Test End Time (TF): <br />245 <br />Final Reading (RF): <br />21 <br />Test Duration (TF — Ti): <br />1 HOUR <br />Change in Reading (RF - RI): <br />0 <br />Pass/Fail Threshold or <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 />OPW BUCKETS <br />EXTRA LARGE BUCKET <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:. Date:7-27-16 <br />' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local <br />requirements may be more stringent. <br />