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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: CHEVRON 99280 Date of Testing: 8/18/2025 <br />Facility Address: 1222 W Atherton, Manteca, CA 95337 <br />Facility Contact: Melissa Avila or Nicole Reiber Phone: 209-239-1751 <br />Date Local Agency Was Notified of Testing: 8/11/2025 <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY INC. <br />Technician Conducting Test: Carlos Zaragoza <br />Credentialsi: r— CSLB Contractor W ICC Service Tech. r_ SWRCB Tank Tester r— Other (Specify) <br />Licensc Number(s): <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used By: F Hydrostatic R Vacuum F Other <br />Test Equipment Used: VACUUM TEST <br />Equipment Resolution: 0.1 gph <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc) <br />Spill Box # Tank Tl <br />REGULAR REGULAR -Fill <br />1 - Direct - Grade level in <br />containment sump <br />Spill Box # Tank T2 <br />PREMIUM PREMIUM - <br />Fill 1- Direct - Grade level <br />in containment sump <br />Spill Box # Tank T3 DIESEI, <br />Biodiesel - Fill 1 - Direct - <br />Grade level in containment <br />sump <br />Spill Box # <br />Bucket Installation Type: <br />C' Direct Bury <br />C: Contained in Sump <br />C Direct Bury <br />C Contained in Sump <br />r Direct Bury <br />C: Contained in Sump <br />r Direct Bury <br />C Contained in Sump <br />Bucket Diameter: <br />12.00 <br />12.00 <br />12.00 <br />Bucket Depth: <br />16.00 <br />16.00 <br />16.00 <br />Wait time between applying <br />vacuum/water and start of test <br />I min <br />1 min <br />I min <br />min <br />Test Start Time (TI): <br />09:00:00 <br />09:05:00 <br />09:10:00 <br />Initial Reading (RI): <br />30.00 in. 1420 <br />30.00 in. H2O <br />30.00 in. H2O <br />Test End Time(TF): <br />09:01:00 <br />09:06:00 <br />09:11:00 <br />Final Reading (RF): <br />30.00 in. H2O <br />30.00 in. H2O <br />30.00 in. H2O <br />Test Duration(TF—TI): <br />1 min <br />1 min <br />1 min <br />Change in Reading (RF—RI) : <br />0.00 in. H2O <br />0.00 in. H2O <br />0.00 in. H2O <br />Pass/Fail Threshold or Criteria: <br />+/-4.00 <br />+/-4.00 <br />+/-4.00 <br />+/- <br />Test Result: <br />Pass <br />Pass <br />Pass <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />Performed Vacuum test on all spill buckets <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: <br />Date: 8/18/2025 <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: 2384685 <br />