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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 USTspill containment structures. The completed form 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 12,2009 <br /> Facility Address: 7611 S.Airport Way,Stockton,CA 95206 <br /> Facility Contact: Mark Hancock and Jim Bunck Phone: 7143893.6140 <br /> Date Local Agency Was Notified of Testing : May 6,2009 <br /> Name of Local Agency Inspector(ifpresent during testing): Mr. 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(Spec) <br /> License Number(s): 525020OUT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc.2 Diesel <br /> Bucket Installation Type: X Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> ❑Contained in SumE ❑Contained in Sump ❑Contained in SumR ❑Contained in Sum <br /> Bucket Diameter: 12 inch <br /> Bucket Depth: 14-1/2 inch <br /> Wait time between applying 5 minutes <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 8:35 a.m. <br /> Initial Reading(R,): 14-1/2 inch <br /> Test End Time(TF): 9:35 a.m. <br /> Final Reading(RF): 14-1/2 inch <br /> Test Duration(TF—T,): 1 hour <br /> Change in Reading(RF-R,): -0- <br /> Pass/Fail Threshold or > 1/16-inch <br /> - - Criteria.- <br /> --- -- - - _- <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 JWoCgaard Date: May 12,2009 <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 />