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L.J <br />AR 0 8 lois <br />PI1�TI�TACLE <br />�•_� -- •• •- Spill Bucket Testing Report FormTL <br />This form is intended for use by contractors performing annual testing of UST spilt containment structures. The comp etVX <br />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: Shell 1-5 1 Date of Testing: 3/7/2016 <br />Facility Address: 717 W Eighth St., Stockton, Ca. 95206 <br />Facility contact: Owner -Joe I Phone: 209-939-0961 <br />Name of Local Agency Inspector (if present during testingt Victoria McCartney <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Pinnacle Fuel Compliance Services, Inc. <br />Technician Conducting Test: Jeff Conger <br />credentials': ® CSLB Contractor ® ICC Service Tech. ® SWRCB Tank Tester ❑Other (Specify) <br />License Number(s): ICC# 1081782 -UT SWRCB# 90-1116 CSLB# 894932 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />®Hydrostatic <br />❑Vacuum <br />❑Other <br />Test Equipment Used: Tape Measure, Stop Watch <br />Equipment Resolution: 1/16" <br />Identify Spill Bucket.(By lank <br />NumberStoredPror/a/ etc. _ <br />#1 -Regular <br />#2 -Premium <br />#3 -Diesel <br />Bucket lrtstallaicri iype: <br />Sum p <br />Sum p <br />Sum p <br />Direct BiI /Sum <br />Bucket Dlarrieier" <br />12" <br />12" <br />12" <br />Bucket 17epth. " <br />13 1/2" <br />14 1/4" <br />14 '/2' <br />Wait time between applying <br />10 mins <br />10 mins <br />10 mins <br />vacuum /water Arid,- cif test' <br />Test Start Time <br />09:08 <br />09:08 <br />09:08 <br />Initial Reading (RI): <br />12 V <br />13'/4" <br />13 7/8° <br />Test End Time (TF): <br />10:08 <br />10:08 <br />10:08 <br />Final Reading (RF): <br />12 V <br />13'/4" <br />13 7/8" <br />Test'Dur6tion (TF' T)- <br />60 mins <br />60 mins <br />60 mins <br />Change in Reading (RF -RIS: <br />0 <br />0 <br />0 <br />Pass/Fs'ilTiirestiald orCriteria� <br />1/8"-60 mins <br />1/8"-60 mins <br />1/8"-60 mins <br />Test Result Pass/Fail <br />PASS, <br />ASS <br />PASS <br />Comments - /include information on repairs made Dnorto tesAno. and recommended follow -un for failed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />/ hereby certify that a// the /nformat/on contained in this report is true, accurate, and in fu// comp/lance with legal requirements. <br />Technician's Signature: <br />Date: 3/7/2016 <br />t State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more <br />stringent. <br />