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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 coniainmenr structures. The cempleted fnrm and prir+loar from <br /> tests{if applicuhlel,should he prodded to the fuc•ility owner/operulor for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name:Pacific Bell Telephone Co.dba AT&T California Date of Testin :05/13/2010 <br /> Facility Address:345 N.SAN JOA UIN STOCKTON CA 95202 GEO PAR#1 UE042 <br /> Facility Contact:Connie Mitchell Facility Phone:209-598-5155 <br /> Date Local Agency Was Notified of Testing:04/27/2010 <br /> Name of Local Agency Inspector if present during testing):Jeff Won San Joaquin Coun <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Com Name:TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test:Victor Guerrero <br /> Credentials: ®CSLBContractor ®ICC Service Tech ❑SWRCB Tanis ❑Other(Specify) <br /> Tester <br /> License Numbers :A ASH HAZB C-10. 588098: 8017001-UT <br /> 3.SPILL.BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Ta a Measure Equipment Resolution: I/16" <br /> he',rrrrf4-Spill Bucket(By Tank Number. 1 UE042U001 2 3 4 <br /> $1oQProducr,etc) <br /> [)Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type ®Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> El on top of AST contop of AST ❑Ontop of AST EJ On top of AST <br /> Bucket Diameter inches 13 114" <br /> Bucket Depth inches 14 112" <br /> Wait Time between applying 1 S MIN <br /> vacuum./water and start of test <br /> Test Start Time: 10:45 AM <br /> Initial Reading Ri): 14" <br /> Test End Time: 11:45 AM <br /> Final Readin 1110: 14" <br /> Test Duration: I HOUR <br /> Chane in Readin Rf-Ri : 0 <br /> Pass/Fail Threshold or Criteria: 0 <br /> Test Result Pass <br /> Comments:All test water used was taken back to Tait's shop. <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 Date 05/13/2010 <br />