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i F P.O.Box 4208 <br /> �io� Sonora CA 95370 <br /> AlltechPetr - / Ca:623541 A-Haz <br /> Phone:209-532-7320 <br /> Compliance without Compromise �P�VtR�PSViEvT�L T Fax:209-533-2650 <br /> A�Tki CirPF�RTC`1!EPl mail@alltechpetro.com <br /> www.alitechpetro.com <br /> Vapor Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco # 1031 Manteca Date of Testing: August 14, 2018 <br /> Facility Address: 2440 Daniel St. Manteca, Ca <br /> Facility Contact: Dave Zizzo Phone: <br /> Name of Local Agency Inspector: Aaron Hang <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 87A Vapor 2 87B Vapor 3 91 Vapor 4 Additive Aux <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® In sump ® In Sump ® In Sump ® In Sum <br /> Wait time between <br /> applying vacuum/water None None None None <br /> and start of test: <br /> Test Start Time (T): 9:00 am 9:00 am 9:00 am 9:00 am <br /> Initial Reading (R): Top of cap Top of cap Top of cap Top of cap <br /> Test End Time (TF): 10:00 am 10:00 am 10:00 am 10:00 am <br /> Final Reading (RF): Top of cap Top of cap Top of cap Top of cap <br /> Test Duration (TF—T): 1 Hour 1 Hour 1 Hour 1 Hour <br /> Change in Reading (RF-R,): None None None None <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail I ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br /> tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> /hereby certify that al/the information contained in this report is true, accurate, and in full compliance with <br /> legal requirements. <br /> Technician's Signature: Date: 08/14/18 <br />