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`~' SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: RIVER POINT LANDING Date of Testing: 1/14/11 <br /> Facility Address: 4950 BUCKLEY COVE `WAY STOCKTON, CA 95219 <br /> Facility Contact: RICH Phone: 209-951-4144 <br /> Date Lacal Agency Was Notified of Testing:12/15/10 <br /> Name of Local Agency Inspector(rf present during testing): GARRETT PARSONS <br /> 2, TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 4162 d Street Galt,CA 95632 (209)744-0112 Far: (209)744-0116 <br /> Technician Conducting Test: ❑ Lyle D.Nimmo 0 Zane A.Nimmo ❑ David A. Winkler ❑ Felix G. Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials': El ICC Service Tech. ❑ SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑ Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: TAPE MEASURE, H2O Equipment Resolution: 1116" <br /> Identify Spill Bucket(By Tank 1 89 2 RED DIESEL 3 4 <br /> Number, ,Stored Product, etc. <br /> Z Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> Bucket Installation Type: F] Contained in F] Contained in <br /> ❑ Contained in Sump E)Contained in Sump Sump Sum <br /> Bucket Diameter: 11 12 <br /> Bucket Depth: 15 12 <br /> Wait time between applying <br /> vacuum/water and start of test: - -- <br /> Test Start Time(T,): 0900 0900 <br /> initial Reading(R[): 14- 10 112 <br /> Test End Time(TF): 1000 1000 <br /> Final Reading(RF): 14- 10 1/2 <br /> Test Duration(TF—Ti): HR HR HR 1 I R <br /> Change in Reading(RF-Rj): 0 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> Test Result: I ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments— (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that ail the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: Date:1-14-11 <br /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor.However, local requirements <br /> may be more stringent. <br />