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I1gCB,January 2006 <br /> Spill Bucket Testing Report Form pIAR 2 7 20171 <br /> This form is intended for use by contractors performing annual testing of UST spill contain t�V <br /> �} he c�leted form and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for su� ory agency. <br /> IS #7111;;^, - <br /> 1. FACILITY INFORMATION <br /> Facility Name: SPANOS JET CENTER Date of Testing: 02-24-17 <br /> Facility Address: 4800 S AIRPORT WAY STOCKTON CA 95206 <br /> Facility Contact: THOMAS Phone: 209-982-1550 <br /> Date Local Agency Was Notified of Testing :01-25-17 <br /> Name of Local Agency Inspector(if present during testing): SAN JOAQUIN CO STACI <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST' 4162 A Street Galt, CA 95632 (209)744-0112 Fax:(209) 744-0116 <br /> Technician Conducting Test: ❑Lyle D.Nimmo ❑ Zane A.Nimmo ❑ David A. Winkler ® Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': ® ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Z Hydrostatic ❑Vacuum_ ❑ Other <br /> Test Equipment Used: TAPE/H2O Equipment Resolution: 1116 <br /> Identify Spill Bucket (By Tank 1 JET 2 JET 3 JET 4 <br /> Number, Stored Product, etc.) <br /> ® Direct Bury ® Direct Bury 0 Direct Bury Ll Direct Bury <br /> Bucket Installation Type: El Contained in E] Contained in <br /> E:] Contained in Sump El Contained in Sump <br /> Sump Sump <br /> Bucket Diameter: 11 11 11 <br /> Bucket Depth: 13 13 12 <br /> Wait time between applying <br /> vacuum/water and start of test: ' <br /> Test Start Time(Ti): 1230 1230 1230 <br /> Initial Reading(Ri): 12 12 11 <br /> Test End Time(TF): 1330 1330 1330 <br /> Final Reading(RF): 12 12 11 <br /> Test Duration(TF--T]): 1 HOUR l HOUR 1 HOUR <br /> Change in Reading(RF-RI): 0 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: Z Pass [] Fail Z Pass ❑Fail Z Pass ❑ Fail ❑ Pass ❑ Fail <br /> COMMentS—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CNI BUCKETS <br /> BUCKETS TESTED TO HOLD 5 GALLONS AND PASSED <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 /> f r <br /> Technician's Signature: Date:02-23-17 <br /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However, local requirements <br /> may be more stringent. <br />