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I <br />0 0 <br />P.O. Box 4208 <br />Sonora CA 95370 <br />trw � Ca: 673541 A -Hoz <br />AiltechPe Phone:209-532-7320 <br />Compliance without Compromise Fax: 209-533-2650 <br />mail@alttechpetro.com <br />www.alltechpetro.com <br />Spill Bucket Testing Report Form <br />n ITV IAICr10RAAT1t%K1- <br />Facility Name: Costco # 1031 Manteca Date of Testing: August 21, 2013 <br />Facility Address: 2440 Daniel St. Manteca, Ca <br />Facility Contact: Julian Ochoa Phone: <br />Name of Local Agency Inspector: Thuy Tran <br />C 011 1 0111- VCT TCCTI KI r- IRI 1=n R RA ATI r1 Ki - <br />Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: 1 -Hour Observed Test Equipment Resolution: 1/16" <br />Identify Spill Bucket <br />1 Reg 87A Vapor <br />2 Reg 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 Sump <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 />9:30 <br />9:30 <br />9:30 <br />9:30 <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 />10:30 <br />10:30 <br />10:30 <br />10:30 <br />Final Reading (Rd: <br />Top of cap <br />Top of cap <br />Top of cap <br />Top of cap <br />Test Duration (TF — TI): <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 />Z Pass ❑ Fail <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />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 />I 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: 4� <br />Date: 8/21/13 <br />