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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 containment structures. The completed form and <br /> printouts from tests(tf applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: JAMAR SVC I Date of Testing: 05-17-18 <br /> Facility Address: 4075 EAST AMIN STREET STOCKTON CALIFORNIA <br /> Facility Contact: JASON Phone: 209-462-4685 <br /> Date Local Agency Was Notified of Testing:04-25-18 <br /> Name of Local Agency Inspector(if present during testing): SAN JOAQUIN CO STACI <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: AFFORDA TEST 416 2nd Street Galt,CA 95632 (209)744-0112 Fax:(209)744-0116 <br /> Technician Conducting Test: ❑Ed Stearns ❑ Zane A.Nimmo ❑ David A.Winkler ® Felix G.Ramirez <br /> 8883080-UT 8883064-UT 8883059-UT 8883072-UT <br /> Credentials: ®ICC Service Tech. ® SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑ VacUUm ❑ Other <br /> Test Equipment Used: TAPE H2O Equipment Resolution: 1/16 <br /> Identify Spill Bucket(By Tank 1 87 2 91 3 4 <br /> Number, Stored Product, etc. <br /> ®Direct Bury ®Direct Bury ❑ Direct Bury F-1DirectBury <br /> Bucket Installation Type: El Contained in El Contained in <br /> El Contained in Sump El Contained in Sump <br /> Sump Sum <br /> Bucket Diameter: 11 I 1 <br /> Bucket Depth: 14 13 <br /> Wait time between applying <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 1100 1000 <br /> Initial Reading(Rj): 13 12 <br /> Test End Time(TF): 1200 1000 <br /> Final Reading(RF): 13 12 <br /> Test Duration(TF—TI): 1 HOUR 1 HOUR <br /> Change in Reading(RF-RI): 0 0 <br /> Pass/Fail Threshold or 0 0 0 0 <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail <br /> Comments— (include irforrmution on repairs inude prior•to testing, and r•ecommended.fcrlloli,-up for foiled tests) <br /> OPW BUKCETS <br /> ALL BUCKETS HOLD 5 GALLON CAPACITY <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:05-17-18 <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 />