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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(f 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 04,2007 <br /> Facility Address: 7611 S.Airport Way,Stockton,CA 95206 <br /> Facility Contact: Jim Bunck Phone: 714-893-6140 <br /> Date Local Agency Was Notified of Testing: May 2,2007 <br /> Name of Local Agency Inspector(fpresent during testing): Muni <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(Spec) <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 ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 24 inch <br /> Bucket Depth: 18 inch <br /> Wait time between applying 3 minutes <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 1:00 P.M. <br /> Initial Reading(Rt): 7-1/4 inch <br /> Test End Time(TF): 2:00 p.m. <br /> Final Reading(RF): 7-1/4 inch <br /> Test Duration(TF—TO: 1 hour <br /> Change in Reading(RF-Rj): -0- <br /> Pass/Fail Threshold or 7-1/16 inch <br /> C_riteria:_ _ <br /> Test Result: (x)Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for jailed tests) <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 NOI0 Faard Date: May 4,2007 <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 />