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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intendedfor use by contractors performing annual testing of USTspill containment structures. The completedform 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: San Joaquin Regional Transit District Date of Testing: 6/27&28/2011 <br /> Facility Address: 1533 E.Lindsay Street, Stockton,California,95205 <br /> Facility Contact: Don Nichols I Phone: (209)943-1111 <br /> Date Local Agency Was Notified of Testing: 6/13/2011 by Afford-A-Test <br /> Name of Local Agency Inspector(fpresent during testing): Jeff Wong,RENS <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: R&D Compliance Testing <br /> Technician Conducting Test: Benjamin F.Duncan Jr. <br /> Credentials: ❑CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): 90-1120/ICC#5246802-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Tape Measure Equipment Resolution: 1/16"x 25' <br /> Identify Spill Bucket(By Tank <br /> 9 Used Oil West 10 Used Oil Center 11 Used Oil East <br /> Number,Stored Product, etc. Remote Fill Remote Fill Remote Fill <br /> Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury Direct Bury <br /> ❑Contained in Sum ❑Contained in Sump ❑Contained in Sum ❑Contained in Sum <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 12" 10%:" 11" <br /> Wait time between applying 5 Minutes 5 Minutes 5 Minutes <br /> water and start of test: <br /> Test Start Time(Tj): 1:20 1:25 1:30 <br /> Initial Reading(RO: 11" 10" 10" <br /> Test End Time(TF): 2:20 2:25 2:30 <br /> Final Reading(RF): 11" W, 10" <br /> Test Duration(TF—T,): 60 Minutes 60 Minutes 60 Minutes <br /> Change in Reading(RF-R,): o" o" 0" <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: X Pass Fail X Pass Fail X Pass Fail`" Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test Fluid supplied and recovered for reuse by,R&D Compliance Testing. <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: .it �Jr� sv �trs+aa►a Date: 6/27&28/2011 <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 />