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Spill Bucket Testing Report Form S WRCB,January 2006 <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed-fi*m1md <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory7r <br /> 1.FACILITY INFORMATION <br /> Facility Name:DP&DK INV.INC. Date of Testing:5/4/2016 <br /> Facility Address:MARCH LANE SHELL 1206 E.MARCH LANE,STOCKTON,CA 95210 <br /> Facility Contact:KARAM SINGH Phone:510-926-7834 <br /> t,. <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Todd Inderbitzen <br /> Credentials]: M CSLB Contractor ICC Service Tech. M SWRCB Tank Tester r7 Other(Specify) <br /> License Number(s):8360841 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: Hydrostatic rl Vacuum r Other <br /> Test Equipment Used:LAKE"PEST Equipment Resolution:0.0625 in. <br /> Identi Spill Bucket B Tank Spill Box#Tank 1 Spill Box#Tank 2 <br /> Identify P ( Y Spill Box#Tank 3 Diesel- <br /> Number,Stored Product, etc. REGULAR-Fill I-Direct- PREMIUM-Fill 1-Direct- <br /> Fill 1-Direct-Grade level Spill Box# <br /> Grade level Grade level <br /> Direct Bury r Direct Bury f Direct Bury C' Direct Bury <br /> Bucket Installation Type: 0 Contained in Sump r Contained in Sump (' Contained in Sump (' Contained in Sump <br /> Bucket Diameter: 13.00 13.00 13.00 <br /> Bucket Depth: 13.50 14.00 11.50 <br /> Wait time between applying <br /> vacuum/water and start of test 5 mm 5 mm 5 min min <br /> Test Start Time(T]): 09:05:00 09:05:00 01:18:00 <br /> Initial Reading(R]): 13.00 in.H2O 13.50 in.H2O 11.00 in.H2O <br /> Test End Time(TF): 10:05:00 10:05:00 02:18:00 <br /> Final Reading(RF): 13.00 in.H2O 13.50 in.H2O 11.00 in.H2O <br /> Test Duration(TF—TI): 1 hr 1 hr 1 hr <br /> Change in Reading(RF—R]): 0.00 in.H2O 0.00 in.H2O 0.00 in.H2O <br /> Pass/Fail Threshold or Criteria: +/-0.00 +/-0.00 +/-0.00 +/- <br /> Test Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> DIESEL FAILED INITIAL TEST/REPLACED PRODUCT CAP AND RETESTED AND PASSED <br /> CERTIFICATION OF TECIINICIAN 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: 5/4/2016 <br /> iState laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent. <br /> WO:2327782 <br />