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I . I s <br />Spill Bucket Testing Report Form SWRCB, January 2006 <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 ('(applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />111\L`V111T1AL1Vlr <br />Facility Name: PERSHING BEACON Date of Testing: 1-30-17 <br />Facility Address: 44457R PERSHING STOCKTON CA 95207 <br />Facility Contact: Daljit in Phone: 477-8004 <br />Date Local Agency Was Notified of Testing :1/24/17 <br />Name of Local Agency Inspector (ifpresent during testing): VICKI <br />El <br />Company Name: AFFORDA TEST 416 2"d Street Galt, 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. ® SWRCB Tank Tester <br />'T CUTTT RTTr 17VC mcam\ 11 lATATw.r.--, <br />Test Method Used: ® Hydrostatic ❑ Vacuum V V ❑ Other , <br />Test Equipment Used: 1120 and tape measure <br />Equipment Resolution: 1/16 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 87 <br />2 91 <br />3 DSL <br />4 <br />Bucket Installation Type: <br />® Direct Bury <br />Contained in Sum <br />❑ p <br />® Direct Bury <br />Contained in Sump <br />®Direct Bury <br />❑ Contained in <br />Sump <br />® Direct Bury <br />❑ Contained in <br />Sum <br />Bucket Diameter: <br />11 <br />11 <br />11 <br />Bucket Depth: <br />14.25 <br />13.75 <br />14 <br />Wait time between applying <br />vacuum/water and start of test: <br />_ <br />- <br />" <br />Test Start Time (T,): <br />I <br />I <br />1 <br />Initial Reading (R,): <br />13 <br />13 <br />13 <br />PFR 10 2017 <br />Test End Time (TF): <br />2 <br />2 <br />2 <br />Final Reading (RF): <br />13 <br />13 <br />13 FN\/IR')NMFNTAI <br />HEA <br />Test Duration (TF —T,): <br />HIR <br />IHR <br />IHR <br />Change in Reading (RF -R,): 1 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />1/16 <br />1/16 <br />1/16 <br />Test Result: I <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing and recommended follow-up or failed tests) <br />OPW ALL PASSED <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` — <br />Date: 1-30-17 <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 />91 <br />fH <br />