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SWRCB , January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form 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 Facility ID : UG010 <br /> Facility Name : Pacific Bell Telephone Co dba ATT California Date of Testing : 3/30/2018 <br /> Facility Address : 1812 Coley Ave . Escalon CA 95320 <br /> Facility Contact: Thuy Tran Phone : (209) 532-3447 <br /> Date Local Agency Was Notified of Testing : 3/22/2018 <br /> Name of Local Agency Inspector (f present during testing) : John Alaniz <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name : TAIT Environmental Services <br /> Technician Conducting Test : Garrett Warren <br /> Credentials ' : OCSLB Contractor ❑x ICC Service Tech . ❑ SWRCB Tank Tester ❑ Other (Spec) <br /> License Number(s) : A B ASB C40 HAZ, 588098 8185019 <br /> 3 . SPILL BUCKET TESTING INFORMATION <br /> Test Method Used : NHydrostatic []Vacuum ❑Other <br /> Test Equipment Used : Tape Measure Equipment Resolution : 1 /16" <br /> Identify Spill Bucket (Bv Tank 1 UG0100001 2 3 4 <br /> Number, Stored Product, etc. ) <br /> []Direct Bury [] Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type : ❑x Contained in Sump [] Contained in Sump ❑ Contained in Sump ❑ Contained in Sump <br /> ❑ On Top of AST 0O Top of AST ❑ On Top of AST ❑ On Top of AST <br /> Bucket Diameter: 11 . 00" <br /> Bucket Depth : 14. 25" <br /> Wait time between applying 15 min . <br /> vacuum/water and start of test : <br /> Test Start Time (Ti) : 12 :38pm <br /> Initial Reading (Rj) : 137/8 <br /> Test End Time (TF) : 1 : 38pm <br /> Final Reading (RF) : 137/8 <br /> Test Duration (TF — TI) : 1 hour <br /> Change in Reading ( RF - Rr) : 0 <br /> Pass/Fail Threshold or 0 <br /> Criteria : <br /> Test Result: ❑x Pass ❑ Fail ❑ Pass s ❑ Fail ❑ Pass [] Fail <br /> Comments — (include information on repairs made prior to testing, and e on-' f i d Sts) <br /> Test water was returned to Tait's shop . <br /> 111A fi 0 2018 <br /> DEPA <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information container) in this report is true, accurate, and in fitll compliance with legal requirements. <br /> Technician ' s Signature : I=V& ?V=wt2 Date : 3/30/2018 <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 />