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AlltechPetr- <br />or <br />Compliance without Compromise <br />I -i r.l��i V tL <br />SEP 0 4 2015 <br />P.O. Box 4208 <br />Sonora CA 95370 <br />Ca: 623541 A-Haz <br />Phone: 209-532-7320 <br />Fax: 209-533-2650 <br />ENVIRONMENTAL mail@alltechpetro.com <br />iJCAi-tj r1e06DT4ACK1T www.alltechpetro.com <br />Vapor Spill Bucket Testing Report Form <br />FACILITY INFORMATION: <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: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: 1 -Hour Observed Test <br />Equipment Resolution: 1/16" <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 Sum <br />E] Direct Bury <br />❑ In sump <br />El Direct Bury <br />In sump <br />El Direct Bury <br />In Sum <br />Wait time between <br />applying vacuum/water <br />and start of test: <br />None <br />None <br />None <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 />Pass/Fail Threshold or <br />Criteria: <br />1/16„ <br />1/16° <br />1/16, <br />1/16" <br />Test Result: <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />[Z Pass ❑ Fail <br />Z Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <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 />CC I I �_ M.- I - - <br />Date: 08/19/15 <br />