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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: CHEVRON 307709 Date of Testing: 3/20/2018 Facility Address: 10858 TRINITY PKWY, STOCKTON, CA 95219 Facility Contact: MANAGER (N-7462-1-10) Phone: 209-952-2213 Date Local Agency Was Notified of Testing: 2/27/2018 Name of Local Agency Inspector (if present during testing): unknown 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY INC. Technician Conducting Test: Jarrod Coukc Credentials): r CSLB Contractor W ICC Service Tech. r SWRCB Tank Tester r Other (Specify) License Number(s): 8155550 3. SPILL BUCKET TESTING INFORMATION Test Method Used By: 7 Hydrostatic W Vacuum r Other Test Equipment Used: VACUUM TEST Equipment Resolution: 0.1 gph Identify Spill Bucket (By Tank Number, Stored Product, etc.) Spill Box # Tank T 1 UNLEADED - Fill 1 - Direct - Grade level in containment sump Spill Box # Tank T-2 PREMIUM - Fill 1 - Direct - Grade level in containment sump Spill Box # Tank T-3 Diesel - Fill 1 - Direct - Grade level in containment sump Spill Box # Bucket Installation Type: f Direct Bury r: Contained in Sump r Direct Bury r Contained in Sump r Direct Bury r Contained in Sump r Direct Bury f Contained in Sump Bucket Diameter: 12.00 12.00 12.00 Bucket Depth: 12.50 12.50 12.50 Wait time between applying vacuum/water and start of test 5 min 5 min 5 min min Test Start Time (Tl): 09:06:00 09:08:00 09:12:00 Initial Reading (Rl): 30.00 30.00 in. H2O 30.00 in. H2O Test End Time(TF): 09:07:00 09:09:00 09:13:00 Final Reading (RF): 27.00 30.00 in. H2O 26.00 in. H2O Test Duration(TF—Tl): 1 min 1 min I min Change in Reading (RF—Rl) : -3.00 0.00 in. H2O -4.00 in. H2O Pass/Fail Threshold or Criteria: +/-4.00 +/-4.00 +/-4.00 +/- Test Result: Pass Pass Pass Coin MCI] ts -(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: C/v Date: 3/20/2018 'State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. WO: 2334431