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P.O. Bax 4208 <br />370 <br />E(; <br />E � Sonar3 419 -haz Ca: 623541 A-Fiaz <br />Alitech SEP 0 4 2015 Phone: 209-532-7320 <br />Compliance without Compromise Fax: 209-533-2650 <br />ENVIRONMENTAL mail@alltechpetro.com <br />HF:A!"rH rIPPAPTAAFNT www.alltechpetro.com <br />"or Spill Bucket Testing Report Form <br />GArii !Tv WFORMATIOW <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 />coli 1 QI IrVI=T TGCTlKlr. 1KIMPnnATHINI- <br />Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: 1 -Hour Observed Test Equipment Resolution: 1/16" <br />I <br />Identify Spill Bucket <br />1 87A Vapor <br />2 87 B Vapor <br />3 Premium Vapor <br />4 Additive Aux <br />Bucket Installation Type: <br />❑ Direct Bury <br />❑ In. Sump <br />❑ Direct Bury <br />In Sump <br />❑ Direct Bury <br />❑ In Sump <br />❑ Direct Bury <br />In Sum <br />Wait time between <br />applying vacuum/water <br />and start of test: <br />None <br />None <br />Nene <br />None <br />Test Start Time (T): <br />8:00 am <br />8:00 am <br />8:00 am <br />8:00 am <br />Initial Reading (R,): <br />Top of cap <br />Top of cap <br />Top of cap <br />Top of cap <br />Test End Time (TF): <br />9:00 am <br />9:00 am <br />9:00 am <br />9:00 am <br />Final Reading (RF): <br />Top of cap <br />Top of cap <br />Top of cap <br />Top of cap <br />Test Duration (TF — T,): <br />1 Hour <br />1 Hour <br />1 Hour <br />1 Hour <br />Change in Reading (RF -R,): <br />None <br />None <br />None <br />None <br />Criteria: <br />Pass/Fait Threshold orLZEa <br />1/16" <br />1/16" <br />1/16" <br />Test Result: <br />s ❑Fail <br />Z Pass ❑ Fail <br />E Pass ❑ Fail <br />® Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for tailed <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />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 />