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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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facilit ID: UG010 Facility Name: Pacific Bell Telephone Co dba ATT California I Date of Testing: 3/30/2018 Facility Address: 1812 Coley Ave. Escalon CA 95320 Facility Contact: Thuy Tran I Phone: (209) 532-3447 Date Local Agency Was Notified of Testing: 3/22/2018 Name of Local Aizencv Inspector (ifpresent during testing): John Alaniz 2. TESTING CONTRACTOR INFORMATION Company Name: TAIT Environmental Services Technician Conducting Test: Garrett Warren Credentials': ®CSLB Contractor ® ICC Service Tech. ❑SWRCB Tank Tester []Other (Spec) License Number(s): A B ASB C-10 HAZ, 588098 8185019 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ®Hydrostatic []Vacuum []Other Test Equipment Used: Tape Measure I Equipment Resolution: 1/16" ,.., .... , .:.. Identify Spill Bucket (Bv Tank Number, Stored Product, etc. ] UG0100001 :n 2 , 3 a r......,. 4 Bucket Installation Type: []Direct Bury ®Contained in Sump ❑On Top of AST []Direct Bury ❑Contained in Sump ❑ On Top of AST ❑Direct Bury ❑Contained in Sump ❑On Top of AST ❑Direct Bury ❑Contained in Sump []On Top of AST Bucket Diameter: 11.00" Bucket Depth: 14.25" Wait time between applying vacuum/water and start of test: 15 min. Test Start Time (Ti): 12:38pm Initial Reading (Rj): 13 7/8" Test End Time (TF): 1:38pm Final Reading (RF): 13 7/8" Test Duration (TF — Tj): 1 hour Change in Reading (RF - Ri): 0 Pass/Fail Threshold or Criteria: 0 Test Result: 0 Pass []Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑Fail Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) Test water was returned to Tait's shop. 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: Ome& Z Date: 3/30/2018 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.