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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 LISTspill containment structures. The completed form and printouts from <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 Date of Testing: 4/25/2017 <br /> Facility Address: 717 W. Eighth Street Stockton <br /> Facility contact: Joe Dan Tran Phone: 209-939-0961 <br /> Name of Local Agency Inspector(if present during testing). <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Pinnacle Fuel Compliance Services, Inc. <br /> Technician Conducting Test: Aneil Chand <br /> Credentials: ®CSLB Contractor ® ICC Service Tech. ®SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): ICC#5119959-UT SWRCB#90-1262 CSLB#894932 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Tape measure,stop watch Equipment ;esolution; 1/1:6" <br /> mom <br /> Identify Spill Bucket(By Tank IL <br /> Number,Stored Product, etc.) Regular Fill <br /> Bucket Installation Type: Sump Lj <br /> Direct Bu /Sum <br /> Bucket Diameter: 12 <br /> Bucket Depth: 14 d <br /> Wait time between applying 15 <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 60mins 13:30 <br /> Initial Reading(RI): 9" <br /> Test End Time(TF): 0 mins 14:30 <br /> Final Reading(RF): 9" <br /> Test Duration(TF-TI): 60 mins <br /> Change in Reading(RF-RI): 0 <br /> Pass/Fail Threshold or Criteria: 1/16-60 <br /> Test Result: Pass/Fail PASS <br /> Comments-(include information on repairs made prior to testing,and recommended follow-up forfailed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> /hereby certify that a//the information contained in this report is true,accurate,and in fu//compliance with legal requirements. <br /> Technician's Signature: — Date: 4/45/2017 <br /> 1 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 /> I <br />