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RECEIVED BY EHD <br /> 7/18/2022 - during inspection sWRCB,January 2oo6 <br /> pill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from 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:Fed Ex Ground Date of Testing:7/6/2021 <br /> Facility Address: 120 S Hansen Road,Tracy,CA 95304 <br /> Facility Contact:Jessie Andrada Phone:916-826-3081 <br /> Date Local Agency Was Notified of Testing: 6/28/2021 <br /> Name of Local Agency Inspector(if present during testing):carol <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Clint Fuhrman <br /> Credentialsi: r CSLB Contractor rv— ICC Service Tech. r SWRCB Tank Tester r Other(Specify) <br /> License Number(s):9160945 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: FV- Hydrostatic F vacuum F Other <br /> Test Equipment Used:LAKE TEST Equipment Resolution:0.0625 in. <br /> ftl <br /> Spill Box#Tank T-1 Diesel Spill Box#Tank T-2 Diesel Spill Box#Tank T-3 <br /> Identify Spill Bucket(By Tank Biodiesel-Fill 1-Direct- <br /> -Fill 1-Direct-Grade level -Fill 1-Direct-Grade level Spill Box# <br /> Number, Stored Product, etc) Grade level in containment <br /> in containment sump in containment sump <br /> sump <br /> Bucket Installation Type: rDirect Bury C Direct Bury r Direct Bury C Direct Bury <br /> C: Contained in Sump C Contained in Sump C: Contained in Sump C Contained in Sump <br /> Bucket Diameter: 12.00 12.00 12.00 <br /> Bucket Depth: 16.00 16.00 16.00 <br /> Wait time between applying <br /> 5 min 5 min 5 min min <br /> vacuum/water and start of test <br /> Test Start Time(TI): 10:10:00 10:10:00 10:10:00 <br /> Initial Reading(Rl): 15.00 in. 15.00 in. 15.00 in. <br /> Test End Time(TF): 11:10:00 11:10:00 11:10:00 <br /> Final Reading(RF): 15.00 in. 15.00 in. 15.00 in. <br /> Test Duration(TF—TI): 1 hr 1 hr 1 hr <br /> Change in Reading(RF—RI): 0.00 in. 0.00 in. 0.00 in. <br /> Pass/Fail Threshold or Criteria: +/-0.00 +/-0.00 +/-0.00 +/- <br /> Test Result: Pass 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 /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: C�1� Date: 7/6/2021 <br /> 'State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. <br /> WO:2350387 <br />