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SWRCB , January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1 . FACILITY INFORMATION Facility ID : 00010 Facility Name : Pacific Bell Telephone Co dba ATT California Date of Testing : 01 /30/2018 Facility Address : 1812 Coley Ave . Escalon CA 95320 Facility Contact: Thuy Tran Phone : 209474-4022 Date Local Agency Was Notified of Testing : 01 -22-2018 Name of Local Agency Inspector (f present during testing) : John Alaniz 2 . TESTING CONTRACTOR INFORMATION Company Name : TAIT Environmental Services Technician Conducting Test : John Cascio Credentials ' : OCSLB Contractor OICC Service Tech . ❑ SWRCB Tank Tester El Other (Spec) License Number(s) : A B ASB C- IO HAZ, 588098 5252163 - UT 3 . SPILL BUCKET TESTING INFORMATION Test Method Used : OHydrostatic ❑Vacuum ❑Other Test Equipment Used : Visual Measure Equipment Resolution: 1 /16" Identify Spill Bucket (Ay Tank 10001 00001 2 3 4 Number, Stored Product, etc.) [] Direct Bury ❑ Direct Bury []Direct Bury ❑Direct Bury Bucket Installation Type : OContained in Sump ❑ Contained in Sump ❑ Contained in Sump [] Contained in Sump ❑ On Top of AST 0 O Top of AST ❑ On Top of AST ❑ On Top of AST Bucket Diameter: 11 . 001, Bucket Depth : 14 . 25" Wait time between applying 15 Min vacuum/water and start of test: Test Start Time (Ti) : 12 : 31 PM Initial Reading (Ri) : 13 . 25" Test End Time (TF) : N/A Final Reading (RF) : N/A Test Duration (TF — Tr) : N/A Change in Reading (RF - Rr) : N/A Pass/Fail Threshold or N/A Criteria : Test Result: ❑ Pass [E] Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail Comments — (include information on repairs made prior to testing, and recommended folloiii- tip for failed tests) VISUAL FAIL , Bucket will not hold water, Lowered water level below the upper gasket and water level still dropped Test Water Returned to Tait CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician ' s Signature : Date : 01 /30/2018 ► State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.