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�7 <br />Juary 2006 <br />Spill Bucket Testing Report For UUllaa P <br />This form is intended for use by contractors performing annual testing of UST spill containment structures �y , �t ®c n <br />orm and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: SAN JOAQUIN MOTORPOOL Date of Testing: 7-27-2016 <br />Facility Address: 121 SAN JOAQUIN ST STOCKTON CA <br />Facility Contact ROBERT Phone: 209-468-2068 <br />Date Local Agency Was Notified of Testing :6-30-16 <br />Name of Local Agency Inspector (tf present during testing): ARIS <br />rC <br />ny Name: AFFORDA TEST 416 2nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 <br />cian Conducting Test: ❑ Lyle D. Nimmo ❑ Zane A. Nimmo ® David A. Winkler ❑ Felix G. Ramirez <br />5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT <br />tialst: ® ICC Service Tech. ®SWRCB Tank Tester <br />--"IL T ♦ TFni►7 <br />Test Method Used: <br />® Hydrostatic <br />1 87 <br />® Direct Bury' <br />❑ Contained in Sump <br />17 <br />22 <br />_ <br />❑ vacuum <br />2 <br />Direct B <br />❑ Contained in Sump <br />❑ Other <br />Equipment Resolution: <br />3 <br />❑ Direct Bury <br />(❑ Contained in <br />SumpSum <br />1/16 <br />4 <br />❑ Direct Bury <br />❑ Contained in <br />Test Equipment Used: TAPE / H2O <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />Bucket Installation Type: <br />BuL,ket Diameter: <br />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TT): <br />1 <br />Initial Reading (RI): <br />21 <br />2 <br />Test End Time (TF): <br />Final Reading (RF): <br />21 <br />Test Duration (TF — Ti): <br />1 HOUR <br />Change in Reading (RF - Ri): <br />0 <br />11-4 f 11M -vrn fnr fniled <br />tests) <br />Pass/Fail Threshold or <br />Criteria: <br />Comments_— (inc u e information on repairs maae priur tu mat 96, "r& <br />QPW 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 requirements <br />may be more stringent. <br />