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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 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:YRC#813 1 Date of Testing:2/14/2024 <br /> Facility Address: 1535 East Pescadero Avenue,Tracy,Ca,95304 <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing : <br /> Name of Local Agency Inspector(fpresent during testing): Paul Nso <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:Confidence UST Services, Inc. <br /> Technician Conducting Test: <br /> Credentials': 0 CSLB Contractor ❑I ICC Service Tech. ❑SWRCB Tank Tester Other(Spec) <br /> License Number(s): 1073977 8339168 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑✓Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Ruler Equipment Resolution:1/16" <br /> Identify Spill Bucket(By Tank 5 6 7 8 <br /> Number, Stored Product, etc.) Motor Oil Waste Oil Tank Field Soap Tank <br /> Bucket Installation Type: 0 Direct Bury 0 Direct Bury 0 Direct Bury 0 Direct Bury <br /> ❑Contained in Sump 0 Contained in Sump ❑Contained in Sum ❑Contained in Sum <br /> Bucket Diameter: 13 12 13 <br /> Bucket Depth: 18 15 221/2 <br /> Wait time between applying <br /> 5 Min 5 Min 5 Min <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 9:19 AM 9:17 AM 9:35 AM <br /> Initial Reading(Rj): 16 11/16" 14 7/16" 20 15/16" <br /> Test End Time(TF): 10:19 AM 10:17AM 9:35 AM <br /> Final Reading(RF): 16 11/16" 14 7/16" 20 15/16" <br /> Test Duration(TF—TI): 60 Min 60 Min 60 Min <br /> Change in Reading(RF-RI): 0" 0" 0" <br /> Pass/Fail Threshold or 1/8" <br /> Criteria: <br /> Test Result: 0 Pass ❑Fail 0 Pass ❑Fail 0 Pass ❑Fail ❑ Pass ❑Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> No repairs required. <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: Date: 2/14/2024 <br /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />