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CEIVED SWRCB, January 2006 Spill Bucket Testing Report Form [ EB 2 12017 This form is intended for use by contractors performing annual testing of UST spill containment structuI-q pleted form and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to tAe , ,(--yrgqlWry agency. 1. FACILITY INFORMATION Facility ID: UG010 Facility Name: Pacific Bell Telephone Co dba ATT California I Date of Testing: 2/3/2017 Facility Address: 1812 Coley Ave. Escalon CA 95320 Facility Contact: Thuy Tran I Phone: (209) 532-3447 Date Local Agency Was Notified of Testing: 1/12/2017 Name of Local Agency Inspector (fpresent during testing): Elena Manzo 2. TESTING CONTRACTOR INFORMATION Company Name: TAIT Environmental Services Technician Conducting Test: Garrett Warren Credentials': 21CSLB Contractor ❑X 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 Equipment Resolution: 1/16" [Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 UG0100001 2 3 4 Bucket Installation Type: E] Direct Bury Z Contained in Sump El On Top of AST El Direct Bury ❑Contained in Sump El 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: 14.50" Wait time between applying vacuum/water and start of test: 15 min. Test Start Time (TI): 10:38am Initial Reading (RI): 14 3/8" Test End Time (TF): 11:38am Final Reading (RF): 14 3/8" Test Duration (TF — Ti): 1 hour Change in Reading (RF - RI): 0 Pass/Fail Threshold or Criteria: 0 Test Result: 1 ❑x 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: VC>rma Date: 2/3/2017 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.