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V4041 ,.. <br /> Spill Bucket Testing Report Form <br /> 1. FACILITY INFORMATION <br /> Facility Name. MARCH&BIANCHI Date of Testing: 11/05/2010 <br /> Facility Address: 1916 E MARCH LANE STOCKTON,CA.95202 <br /> Facility Contact: GET Phone: 209-954-0945 <br /> Date Local Agency was notified of Testing: 11/01/2010 <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:dames 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 /> Test Method Use: s Hydrostatic Vacuum Other <br /> Test Egeipmeet Used: Pump Equipment Resolution: <br /> Identify Spill Bucket(By Tank L UNLEADED 2.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: 15.25" 15.50" 14.75" <br /> Watt time between applying 15 MIN 15 MIN 15 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(T1): 09:30:00 AM 09:30:00 AM 09:30:00 AM <br /> Initial Reading(RI): 14.25" 14.50" 13.75" <br /> Test End Time(Tf): 10:30:00 AM 10:30:00 AM 10:30:00 AM <br /> Final Reading(Rf): 14.25" 14-W 13.75" <br /> Test Duration(Tf-Tl): 1 HR I HR I HR <br /> Change in Reading(Rf-Ri): 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 nrior to testine.and recommended follow-up for failed tests) <br /> Ce ifi do otTechnician Responsible for Conducting This Testing <br /> 1 hereby certify that all the iA in in this report is true,and in full compliance with legal requirements. <br /> Technician's Signature: �< 4 Date: 11/05/2010 <br /> C/ <br />