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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:7-Eleven 38153 Date of Testing:4/24/2025 <br /> Facility Address: 121 S.Center Street,Stockton,CA 95202 <br /> Facility Contact:manager Phone:209-361-8332 <br /> Date Local Agency Was Notified of Testing:4/24/2025 <br /> Name of Local Agency Inspector(if present during testing):UNKNOWN <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Jesus Saldivar <br /> Credentialsl: F CSLB Contractor ICC Service Tech. F SWRCB Tank Tester F Other(Specify) <br /> License Number(s): <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: r Hydrostatic F Vacuum Other <br /> Test Equipment Used:VACUUM TEST Equipment Resolution:0.1 gph <br /> Spill Box#Tank Tl: Spill Box#Tank T2: Spill Box#Tank T3:DIESEL <br /> Identify Spill Bucket(By Tank REGULAR UNLEADED PREMIUM UNLEADED Diesel-Fill 1-Direct- Spill Box# <br /> Number,Stored Product, etc) REG UNLEAD-Fill 1- PREMIUM-Fill 1-Direct- Grade level <br /> Direct-Grade level Grade level <br /> rDirect Bury r Direct Bury r Direct Bury r Direct Bury <br /> Bucket Installation Type: (o Contained in Sump fo Contained in Sump fo Contained in Sump r Contained in Sump <br /> Bucket Diameter: 12.00 12.00 12.00 <br /> Bucket Depth: 15.00 15.00 15.00 <br /> Wait time between applying <br /> 1 min 5 min 1 min min <br /> vacuum/water and start of test <br /> Test Start Time(Tl): 09:00:00 09:00:00 09:02:00 <br /> Initial Reading(Rl): 30.00 in.H2O 14.00 in.H2O 30.00 in.H2O <br /> Test End Time(TF): 09:01:00 10:00:00 09:03:00 <br /> Final Reading(RF): 28.00 in.H2O 14.00 in.H2O 27.00 in.H2O <br /> Test Duration(TF—T,): 1 min 1 hr 1 min <br /> Change in Reading(RF—RI): -2.00 in.H2O 0.00 in.H2O -3.00 in.H2O <br /> Pass/Fail Threshold or Criteria: +/-4.00 +/-0.00 +/-4.00 +/- <br /> Test Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Was not able to pull vacuum on PREM. spill bucket do to nipple being to long.All spill buckets tested and passed. <br /> CERTIFICATION OF TECBMCIAN 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: a - Date: 4/24/2025 <br /> t 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:2379242 <br />