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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:3/24/2017 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: Name of Local Agency Inspector(if present during testing):ceaser r 2.TESTING CONTRACTOR INFORMATION Company Name:TANKNOLOGY INC. Technician Conducting Test:Steve Willems Credentials): r CSLB Contractor r ICC Service Tech. r SWRCB Tank Tester r Other(Specify) License Number(s):A 3.SPILL BUCKET TESTING INFORMATION Test Method Used By: r Hydrostatic r vacuum r Other Test Equipment Used:LAKE TEST I Equipment Resolution:0.0625 in. Spill Box#Tank T I Spill Box#Tank T-2 Spill Box#Tank T-2 Spill Box#Tank T-3 Diesel Identify Spill Bucket(By Tank UNLEADED-Fill 1-Direct PREMIUM-Fill 1-Direct- PREMIUM-Fill 1-Direct- Number, Stored Product, etc.) -Grade level in Grade level in containment Grade level in containment 'Fill 1-Direct-Grade level containment sump sump sump in containment sump Direct Bury �' Direct Bury r- Direct Bury T Direct Bury Bucket Installation Type: t: Contained in Sump r Contained in Sump 0; Contained in Sump r Contained in Sump Bucket Diameter: 12.00 12.00 12.00 12.00 Bucket Depth: 12.50 12.50 12.50 12.50 Wait time between applying 5 min 5 min 1 min 5 min vacuum/water and start of test Test Start Time(TI): 13:02:00 13:02:00 15:26:00 13:02:00 Initial Reading(Rl): 12.25 in.H2O 12.00 in.H2O 30.00 in.HG 12.25 in.H2O Test End Time(TF): 14:02:00 13:47:00 15:27:00 14:02:00 Final Reading(RF): 12.25 in.H2O 11.50 in.H2O 30.00 in.HG 12.25 in.H2O Test Duration(TF-TI): 1 hr 45 min 1 min 1 hr Change in Reading(RF-RI): 0.00 in.H2O -0.50 in.H2O 0.00 in.HG 0.00 in.H2O Pass/Fail Threshold or Criteria: +/-0.00 +/-0.00 +/-4.00 +/-0.00 Test Result: Pass Fail Pass Pass Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) replaced the drain and shut off ring on the 91 fill,spill buckets pass tightness but not capacity. CERTIFICATION OF TECE MCIAN RESPONSIBLE FOR CONDUCTING TIRS TESTING /hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signature: I' qs— Date: 3/24/2017 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. WO:2330296