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P.o. Box 4208 <br />Sonora CA 95370 <br />}Ca: 623541 A-Haz <br />Alitech ll r p 2G��6 <br />�V� (1 � Phone: 209-532-7320 <br />Cofnpliance Without Comprofni5e Fax: 209-533-2650 <br />kit— <br />mail@alltechpetro.com <br />www.a I ltech petro.com <br />Spill Bucket Testing Report Form <br />FACILITY INFORMATION: <br />Facility Name: Costco # 1031 Manteca I Date of Testing: August 18, 2016 <br />Facility Address: 2440 Daniel St. Manteca, Ca <br />Facility Contact: Julian Ochoa 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 Fill <br />2 87 B Fill <br />3 91 Fill <br />4 Additive Fill <br />Bucket Installation Type: <br />❑ Direct Bury <br />M In Sump <br />❑ Direct Bury <br />® In Sump <br />❑ Direct Bury <br />Z 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 />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 />3 1/4" above cap <br />4" above cap <br />4 3/8" above cap <br />1 1/8" above 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 />3 1/4" above cap <br />4" above cap <br />4 3/8" above cap <br />1 1/8" above cap <br />Test Duration (T,—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 />N Pass ❑ Fail <br />® Pass ❑ Fail <br />M Pass ❑ Fail <br />M 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 />ilc <br />Date: 08/18/16 <br />