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' . 9. SII Bucket Testing Repor 71 orm SWRCB, January 2006 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 3 0 7 7 0 9 Date of Testing: 09/14/2009 Facility Address: 10858 TRINITY PKWY STOCKTON, CA, 95210 Facility Contact: MANAGER Phone: (2 0 9) 952-2213 Date Local Agency Was Notified of Testing Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: STEVEN WILLEMS Credentials 1: ❑ CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Specify) License Number: 3. SPILL BUCKET TESTING INFORMATION Test Method Used: Ffl Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: tape measure Equipment Resolution: no leak loss Identify Spill Bucket(By Tank Number, Stored Product, etc) 1 1 UNL FILL 2 2 PRE FILL 3 3 DIE FILL 4 1 UNL FILL Bucket Installation Type: El Direct Bury ❑X Contained in Sump ❑ Direct Bury X❑ Contained in Sump ❑ Direct Bury X❑ Contained in Sump E] Direct Bury X❑ Contained in Sump Bucket Diameter: 12 12 12 12 Bucket Depth: 14.5 13 13.75 14.5 Wait time between applying vacuum/water and starting test: 5 mins 5 mins 5 mins 5 mins Test Start Time (Tl ): 1431 1418 1418 1441 Initial Reading (Rl ): 13.75 12.25 12.875 13.75 Test End Time (TF ): 1433 1518 1518 1443 Final Reading (R F ): 12.5 12.25 12.875 12.5 Test Duration: 2 mins 1 hour 1 hour 2 mins Change in Reading (R F- R1 ): 1.25 0 0 1.25 Pass/Fail Threshold or Criteria: visual visual visual visual Test Result: ❑ Pass [Z] Fail [fl Pass ❑ Fail 1fl Pass ❑ Fail ❑ Pass [K] Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) checked rubber seals around the outside of the 87 fill spill bucket, they were in good condition. spill bucket visually appeared to be in slight oval shape on side of bucket. _retested spill bucket and water still continued to leak from top side of spill bucket. repair and retest. 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:Date: 09/14/2009 1 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements