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P.O. Box 4208 <br />RE I Sonora CA 95370 <br />Ailtech,. <br />Ca: 623541 A-Haz <br />SEP Q 4 2015 Phone: 209-532-7320 <br />Compliance without Compromise Fax: 209-533-2650 <br />ENVIRONMENTAL <br />mail@alltechpetro.com <br />HFA!TI-1r11=PARTAAF:NT www.alltechpetro.com <br />Fill Spill Bucket Testing Report Form <br />CArll ITV 1K1r_0R'n/IATIl1N- <br />Facility Name: Costco # 1031 Manteca Date of Testing: August 19, 2015 <br />Facility Address: 2440 Daniel St. Manteca, Ca <br />Facility Contact: Dave Zizzo Phone: <br />Name of Local Agency Inspector: Jeff Wong <br />SPILL BUCKET TESTING INFORMATION: <br />Test Method Used: E Hydrostatic <br />Test Equipment Used: 1 -Hour Observed Test <br />Identify Spill Bucket <br />Bucket Installation Type: <br />Wait time between <br />applying vacuum/water <br />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 -R,): <br />Pass/Fail Threshold or <br />Criteria: <br />Test Result: <br />1 87A Fill <br />❑ Direct Bury <br />11�q In Sumn <br />None <br />U Vacuum <br />2 87BFill <br />❑ Direct Bury <br />Z In Sump <br />None <br />U Other <br />Equipment Resolution: 1/16" <br />3 Premium Fill <br />❑ Direct Bury <br />® in Sump <br />None <br />4 Additive Fill <br />❑ Direct Bury <br />® In Sump <br />None <br />8:00 am <br />8:00 am <br />8:00 am <br />8:00 am <br />3 1/4" above cap <br />4" above cap <br />4 3/8" above cap <br />1 1/8" above cap <br />9:00 am <br />9:00 am <br />9:00 am <br />9:00 am <br />3 1/4" above cap <br />4" above cap <br />4 3/8" above cap <br />1 1/8" above cap <br />1 Hour <br />1 Hour <br />1 Hour <br />1 Hour <br />None <br />None <br />None <br />None <br />1/16" <br />1/161, <br />1/16" <br />1/16" <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />Z Pass ❑ Fail <br />E Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br />tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1 hereby certify that all the information contained in this report is true, accurate, and in full compliance with <br />legal requirements. <br />Technician's Signature: <br />Date: 08/19/15 <br />