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-� RECEIVE[ <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form JAN 3 0 2014 <br /> This form is intended for use by contractors performing ungual testing of UST spill containment struct f� <br /> printouts from tests(f applicable),should be provided to the facility owner/operator for submittal to tft AL <br /> 1, FACILITY INFORMATION <br /> Facility Name: RIVER POINT LANDING Date of Testing: 01-14-14 <br /> Facility Address: 4950 BUCKLEY CLOVE WAY STOCKTON CA <br /> Facility Contact: ANDREW Phone: 209-951-4144 <br /> Date Local Agency Was Notified of Testing:12-12-13 <br /> Name of Local Agency Inspector({f present during testing,): SAN JOAQUIN CO GARRETT <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Gait,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: Lyle D.Nimmo ❑ Zane A.Nimmo ❑ David A. Winkler ® Felix G.Ramirez <br /> 5249115-UT 5263322-UT 5263373-UT 5273934-UT <br /> Credentials: ® ICC Service Tech, E SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test F,quipment Used: TAPE I H2O Equipment Resolution: 1 10 <br /> Identify Spill Bucket(41, Tunk I DIESEL 2 87 3 4 <br /> Number, Stored Product, etc. <br /> Direct Bury ®Direct Bury El Direct Bury Direct Bury <br /> Bucket Installation Type: El Contained in E] Contained in <br /> ❑ Contained in Sump ❑Contained in Sump Sump Sum <br /> Bucket Diameter: I 1 I I <br /> Bucket Depth: ]3 14 <br /> Wait time between applying _ <br /> vacuum/water and start of test: <br /> Test Start Time(T[): 900 900 <br /> Initial Reading(Rt): I? 13 <br /> Test End Time(TF): 1000 1000 <br /> Final Reading(RF): 12 13 <br /> Test Duration(TF—Tt): 1 HOUR I HOUR <br /> Change in Reading(RF-Rt): 0 0 <br /> Pass/Fail Threshold or _ <br /> Criteria: <br /> Test Result: X Pass Fail E Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-u for failed 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 legal requirements. <br /> Technician's Signature: t' Date:O1-14-14 <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 />