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RECF- <br /> -NED <br /> J`'J I bk&lnuary 2006 <br /> Spill Bucket Testing Report Form ,MENTAL <br /> VIRON <br /> This form is intended for use by contractors performing annual testing of UST spill containment stAile- <br /> rt��ss�7 fgap7� �m and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal 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 2"1 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 ❑ Direct Bury <br /> Bucket Installation Type: El Contained in F-1 Contained in <br /> El Contained in Sump El Contained in Sump Sump Sum <br /> Bucket Diameter: I I 11 <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 1100 <br /> Final Reading(RF): 13 12 <br /> Test Duration(TF—Ti): I 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 ❑ Nass ❑ Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> OPW BLIKCETS <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 />