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SWRCB,January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1.FACILITY INFORMATION Facility Name:TESORO/SPEEDWAY#68154 Date of Testing:6/27/2024 Facility Address:2500 W LODI,LODI,CA 95242 Facility Contact: Phone:- Date Local Agency Was Notified of Testing: 6/20/2024 Name of Local Agency Inspector(if present during testing):MARIA LOPEZ 2. TESTING CONTRACTOR INFORMATION Company Name:TANKNOLOGY INC. Technician Conducting Test:Jesus Saldivar Credentials l: r— CSLB Contractor 1W ICC Service Tech. r— SWRCB Tank Tester r— Other(Specify) License Number(s): 3. SPILL BUCKET TESTING INFORMATION Test Method Used By: 1W Hydrostatic F Vacuum F Other Test Equipment Used:LAKE TEST Equipment Resolution:0.0625 in. Spill Box#Tank 1 Spill Box#Tank 2 Spill Box#Tank 3 Spill Box#Tank 4 Diesel- Identify Spill Bucket(By Tank REGULAR-Fill 1-Direct- MIDGRADE-Fill 1-Direct PREMIUM-Fill 1-Direct- Fill 1-Direct-Grade level Number, Stored Product, etc) Grade level in containment -Grade level in Grade level in containment sump containment sump sump in containment sump Bucket Installation Type: rDirect Bury C Direct Bury r Direct Bury C Direct Bury C: Contained in Sump C Contained in Sump C: Contained in Sump C Contained in Sump Bucket Diameter: 12.00 12.00 12.00 12.00 Bucket Depth: 12.00 12.00 12.00 12.00 Wait time between applying 5 min 5 min 5 min 5 min vacuum/water and start of test Test Start Time(Tl): 07:45:00 07:45:00 07:45:00 07:45:00 Initial Reading(Rl): 12.00 in.1420 12.00 in.H2O 12.00 in.H2O 12.00 in.H2O Test End Time(TF): 08:45:00 08:45:00 08:45:00 08:45:00 Final Reading(RF): 12.00 in.H2O 12.00 in.H2O 12.00 in.H2O 12.00 in.H2O Test Duration(TF—TI): 1 hr 1 hr 1 hr 1 hr Change in Reading(RF—RI): 0.00 in.H2O 0.00 in.H2O 0.00 in.H2O 0.00 in.H2O Pass/Fail Threshold or Criteria: +/-0.00 +/-0.00 +/-0.00 +/-0.00 Test Result: Pass Pass Pass Pass Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: Al Date: 6/27/2024 'State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. WO:2364985