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RECEIVED <br /> NOV 2 9 2012 <br /> ENVIRONMENTAL HEALTH <br /> PERMITISERVICES <br /> Spill Bucket Testing Report Form <br /> /. FACILITY INFORMATION <br /> Facility Name: MARCH&BIANCHI Date of Testing: 1121/2012 <br /> Facility Address: 1916 E MARCH LANE STOCKTON,CA.95202 <br /> Facility Contact: GET Phone: 209-9544M <br /> Date Local Agency was notified of Testing: 11/012010 <br /> Name of Local Agency Inspector(if present during testing:) GARRET RUCKUS <br /> 2.TESTING CONTRACTOR INFROMATION <br /> Company Name:Mid Valley Consulting&General Engineering <br /> Technician Conducting Test:James Day <br /> Credentials: CSLB Contractor ICC Service Tech. SWRCB Tank tester <br /> License Number(s): 920985 873644-UT <br /> 1. SPILL BUCKET TESTING INFORMATION <br /> Tart Method Use: a Hydrostatic Vacuum Other <br /> Teat Equipment Used: Pump Equipment Resolution: <br /> Identify Spill Bucket(By Tank L UNLEADED 2.PREMIUM 3.DIESEL 4 <br /> Number,Stored Product) <br /> Bucket Instalition Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 15.25" 15.50" 14.75" <br /> Wait time between applying 15 MIN 15 MIN 15 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 09:00 AM 09:00 AM 09:00 AM <br /> Initial Reading(R1): 14.25" 14.50" 13.75" <br /> Test End Time(Tf): 10:00 AM 10:00 AM 10:00 AM <br /> Final Reading(RQ: 14.25" 14.50" 13.75" <br /> Test Duration(Tf-Tl): 1 HR 1 HR 1 HR <br /> Change in Reading(Rf-Rl): 0 0 0 <br /> Pass/Fail Threshold or Criteria: .025" .025" .025" <br /> Test Results: X Pass Fail X Pass Fail X Pass Fail Pass Fail <br /> Comments: - (include infromation on repairs made prior to testing,and recommended follow-up for failed tests) <br /> Cc 1i <br /> Fthh <br /> iscnician Responsible for Conducting This Testing <br /> I hereby certify that all the inf report is true,and in full compliance with legal requirements. <br /> Technician's Signature: Date: 11/212012 <br />