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SWRCB, January 2006 <br />PINNACLE Spill Bucket Testing Report Form <br />This form is intended for use by contractors performing annual testing of USTspill 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 1-5 Date of Testing: 3/5/2014 <br />Facility Address: 717 W Eighth St., Stockton, Ca. 95206 <br />Facility Contact: Owner Phone: 209-939-0961 <br />Name of Local Agency Inspector (Ypresent during testingf. Thuy Tran <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: ®Hydrostatic []Vacuum ❑Other <br />Test Equipment Used: Tape Measure, Stop Watch Equipment Resolution: 1/16" <br />entify Spill Bucket (By Tank <br />umber, Stored Product,etc. #1 -Regular <br />F <br />#2 -Premium #3 -Diesel <br />cket Installation Type: Sump <br />Direct Bu /Sum' <br />Sump Sump <br />Bucket Diameter: 12" <br />12" 12" <br />Bucket Depth: 15" <br />15" 15" <br />Wait time between applying 10 mins <br />vacuum/water and start of test: <br />10 mins 10 mins <br />Test Start Time (TI): 09:40 <br />09:40 09:40 <br />Initial Reading (RI): 12 11/16" <br />13 1/2" 13 7/8" <br />Test End Time (TF): 10:40 <br />10:40 10:40 <br />Final Reading (RF): 12 11/16" <br />13 1/2" 13 7/8" <br />Test Duration (TF -TI): 60 mins <br />60 mins 60 mins <br />Change in Reading (RF -RI): 0 <br />0 0 <br />Pass/Fail Threshold or Criteria: 1/8"-60 mins <br />1/8"-60 mins 1/8"-60 mins <br />Test Result: Pass/Fail PASS <br />PASS PASS <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed 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// comp/lance with legal requirements <br />Technician's Signature: Date: 3/5/2014 <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 />