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Spill Bucket Testing Report Form <br /> 1. FACILITY INFORMATION <br /> Facility Name: MARCH&BIANCHI Date of Testing: 11/04/2011 <br /> Facility Address: 1916 E MARCH LANE STOCKTON,CA.95202 <br /> Facility Contact: GET Phone: 209-9544M <br /> Date Local Agency was notilkd of Testing: 111012010 <br /> Name of Local Agency Inspector(if present during testing:) GARRET RUCKUS <br /> 2.7ESTING 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): 920M 973644-1Tf <br /> 1. SPILL BUCKET TESTING INFORMATION <br /> Test Method Use: a Hydrostatic Vacuum Other <br /> Test Equipment Used: Pump Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1.UNLEADED L PREMIUM 3.DIESEL 4 <br /> Number,Stored Product) <br /> Bucket Installtion 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: 1525" 15.50" 14.75" <br /> Wait time between applying 15 MIN ]5 MIN 15 MIN <br /> vacuumMater and start of test: <br /> Test Start Time(TI): 09:30:00 AM 09:30,00 AM 09:30:00AM <br /> Initial Reading(R]): 1425" 1450" 13.75" <br /> Test End Time(Tf): 10.30:00 AM 10*30.00 AM 10:30:00 AM <br /> Final Reading(Rf): 1425" 14.50" 13.75" <br /> Test Duration(Tf-Tl): 1 HR I HR I HR <br /> Change in Reading(Rf-Rl): 0 0 0 <br /> Pass/Fail Threshold or Criteria: A25" .025" .025" <br /> Test Results: X Pass Fail X Pass Fail X Paas Faff Pass Fail <br /> Comments: -(include information on repairs made prior to testing and recommended follow-tm for failed tests) <br /> Certification of Technician Responsible for Conducting This Testing <br /> I hereby certify that all the in ti a 'n this report is true,and in full compliance with legal requirements. <br /> Technician's Signature: Date: 11/04/2011 <br />