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Work Order: 2262763 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> Ais farm is intended far use by contractors performing annual testing of UST spill cantaimnent structures The completed form and <br /> printouts from tests(if applicable),should he provided to the facility awner'operator for.submitral to ttte local regulwory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: CO'STCOR 1031 Date of Tenting: 1/15/2009 <br /> I <br /> Facility Address: 2440 DANIELS ST.,MANTECA,CA <br /> Facility Contact: MANAGER Phone: 203-823-0591 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector Ofpresent during testing): , <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY <br /> I <br /> Technician Conducting Test: BRIAN MCPHEELY <br /> Credemiials': I.-i CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Utber{Spec:) <br /> License Number(s): 8010945-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used- ❑Hydrostatic X Vacuum }0 Other <br /> VACUUM <br /> DONUT <br /> Equipment Resotution-, <br /> Test Equipment Used: _ f <br /> Identify Spill Bu 91cket(By 7arut . 1 87-1 2 87-2 3 4 <br /> ber,Stared Product,etc, I ❑Direct Bury ❑Direct Bury L1 Direct Bury ❑Direct BuryBucket Installiation Type: X Contained in Sura X Contained in SumX Cor�#ained in S Contained in <br /> Bucket Diameter: 12 12 12 <br /> Bucket Depth: 16 153/4 14 112 <br /> Wait time between applying 30SEC 30SEC 30SEC <br /> vacuum/water and start of test: <br /> Test Start Time(T,): 9:33 I0:01 10:09 <br /> Initial Reading(RI): 30"C 30 WC 30INWC <br /> Test End Time(Ta): 9:34 10:02 10:10 <br /> Final Reading(RF): <br /> 28INWC 26 INWC 30"C <br /> Test Duration{1 F—T,}: 60SEC 60 SEC 60 SEC <br /> Change in Reading(RF-R,): 21NWC 4 INWC 0[NWC <br /> pass/Fa Threshold or 4INWC 60 SEC 4 INWC 60 SEC 4 INWC 60 SEC <br /> Criteria. <br /> C <br /> `est 3 Pte,. .I:1Fsti1_. <br /> �. �. <br /> Comments—(include to Mm-attan on re irs madePrior to testing, wrd recommended ollaw-u ar ailed 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 fall compliance with legal requirements. <br /> Date: 1/15/2009 <br /> Technician's Signature: <br /> State taws and regulations do not currently require testing to be performed by a Qualified contractor.However,local requirements <br /> may be more stringent. <br /> Tanknology Inc. 8501 N.MoPac Expressway, Suite 400,Austin,Texas 78759 <br />