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.i <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform 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: Estes Trucking I Date of Testing: May 27,2008 <br /> Facility Address: 7611 S.Airport Way,Stockton,CA 95206 <br /> Facility Contact: Jim Bunck I Phone: 714-893-6140 <br /> Date Local Agency Was Notified of Testing: May 19,2008 <br /> Name of Local Agency Inspector('(present during testing): Muniappa Naidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPMENT CO. INC. <br /> Technician Conducting Test: Eric Molgaard <br /> Credentials: ❑CSLB Contractor (x)ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): ICC 5250200-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: (x)Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Tape and Water Finding Paste Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 DIESEL FUEL 2 3 4 <br /> Number, Stored Product, etc. <br /> Bucket Installation Type: (x)Direct Bury [I Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑Contained in Sum ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: <br /> Bucket Depth: <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(T,): <br /> Initial Reading(R,): <br /> Test End Time(TF): <br /> Final Reading(RF): <br /> Test Duration(TF—T,): <br /> Change in Reading(RF-RO: <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: Pass ®Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing and recommended follow-up for failed tests) <br /> BUCKET HAS VISIBLE DAMAGE TO UPPER SECTION OF BUCKET. NEEDS TO BE <br /> REPAIRED OR REPLACED <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: Eric Nofgaard Date: May 27,2008 <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 />