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� CE IED <br /> Spill Bucket Testing Report Form <br /> 1. FACILITY INFORMATION DEC 18 2020 <br /> Facility Name: MARCH&BIANCHI Date of Testing: 11/16/2017 VIROW&iTAL HEW 1H <br /> Facility Address: 1916 E MARCH LANE STOCKTON,CA.95202 c�-n n i Tj S E <br /> Facility Contact: JEET Phone: 209-954-0945 <br /> Date Local Agency was notified of Testing: <br /> Name of Local Agency Inspector(if present during testing:) <br /> 2.TESTING CONTRACTOR INFROMATION <br /> Company Name:Mid Valley Consulting&General Engineering <br /> Technician Conducting Test:BRIAN ROTH <br /> Credentials: CSLB Contractor ICC Service Tech. SWRCB Tank tester <br /> License Number(s): 920985 8343838-UT <br /> 1. SPILL BUCKET TESTING INFORMATION <br /> Test Method Use: x Hydrostatic Vacuum Other <br /> Test Equipment Used: Pump Equipment Resolution: <br /> Identify Spill Bucket(By Tank L UNLEADED 2.PREMIUM 3.DIESEL 4 <br /> Number,Stored Product) <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 15.25" 1550" 14.75" <br /> Wait time between applying 15 MIN 15 MIN 15 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 9:00 am 9:00 am 9:00 am <br /> Initial Reading(Rl): 14.25" 14.50" 13.75" <br /> Test End Time(Tf): 10:00 am 10:00 am 10:00 am <br /> Final Reading(Rt): 14.25" 14.50" 13.75" <br /> Test Duration(Tf-Tl): 1 HR 1 HR 1 HR <br /> Change in Reading(Rf-RI): 0 0 0 <br /> Pass/Fail Threshold or Criteria: .025" .025" .025" <br /> Test Results: X Pass Fail I X Pass Fail X Pass Fail Pass Fail <br /> Comments: - (include information on repairs made prior to testing.and recommended follow-un for failed tests) <br /> Buckets were verified to be 5all�ons plus a <br /> Certification of Technician Responsible for Conducting This Testing <br /> I hereby certify that all the infor ati in this report is true,and in full compliance with legal requirements. <br /> Technician's Signature: Date: 11/16/2017 <br />