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%00 <br />IIW <br />RECEIVED <br />FEB 12 2016 <br />Spill Bucket Testing Report Form ENVIRONMENTAL <br />L FACILITY INFORMATION <br />Facility Name: Pershing Gas Date of Testing: 1/28/2016 Nqprrr <br />Facility Address: 4445 Pershing Avenue, Stockton CA 95207 <br />Facility Contact: Phone: <br />Date Local Agency was notified of Testing: 1/21/2016 <br />Name of Local Agency Inspector (if present during testing:) <br />2.TESTING CONTRACTOR INRROMATInN <br />Company Name: Mid Valley Consulting & General Engineering <br />Technician Conducting Test: Jason Haase 8165490 <br />Credentials: CSLB Contractor ICC Service Tech. SWRCB Tank tester <br />License Number(s): 920985 873644 -UT <br />1. SPILL BUCKET TESTING INFORMATION <br />Test Method Use: z Hydrostatic Vacuum Other <br />Test Equipment Used: Pump Equipment Resolution: <br />Comments: - (include infromation on repairs made prior to testing. and recommended follow-uo for failed tests) <br />Certification of Technician Responsible for Conducting This Testing <br />1 hereby certify that all the imation in this report is true, and in full compliance with legal requirements. <br />Technician's Signature �;)'r dw- 4�� Date: 1/2W2016 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product) <br />I LUNLEADED <br />2PREMI M <br />3DIESEL <br />4 <br />Bucket Instalition Type: <br />XDirect Bury <br />Contained in Sump <br />X Direct Bury <br />Contained in Sump <br />X Direct Bury <br />Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Bucket Diameter: <br />Bucket Depth: <br />14" <br />13.75" <br />13 <br />Wait time between applying <br />vacuum/water and start of test: <br />15 MRV <br />15 MIN <br />15 MIN <br />Test Start Time (Ti): <br />9:00 <br />9:00 <br />9:00 <br />Initial Reading (Rl): <br />13" <br />12.75 <br />12" <br />Test End Time (Tt): <br />10:00 <br />10:00 <br />10:00 <br />Final Reading (Rt): <br />13" <br />12.75" <br />12" <br />Test Duration (Tf-Tl): <br />I <br />1 HR <br />1 HR <br />IHR <br />Change in Reading (Rf-Rl): <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or Criteria: <br />.25" <br />.25" <br />.25" <br />Test Results: <br />X Pass Fail <br />X Pass Fail <br />X Pass Fail Pass Fail <br />Comments: - (include infromation on repairs made prior to testing. and recommended follow-uo for failed tests) <br />Certification of Technician Responsible for Conducting This Testing <br />1 hereby certify that all the imation in this report is true, and in full compliance with legal requirements. <br />Technician's Signature �;)'r dw- 4�� Date: 1/2W2016 <br />