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RECEIVE <br /> N 0 22015 <br /> Spill Bucket Testing Report Form ENVIRONJAN <br /> 1. FACILITY INFORMATION L <br /> Facility Name: MARCH&BIANCHI Date of Testing: 11/18/2014ANTI 17;:04P r5AcR1 <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: 10/29/2014 <br /> Name of Local Agency Inspector(if present during tesfing:) <br /> 2.TESTING CONTRACTOR INFROMATION <br /> Company Name:Mid Valley Consulting&General Engineering <br /> Technician Conducting Test:Jason Haase <br /> Credentials: CSLB Contractor ICC Service Tech. SWRCB Tanktester <br /> License Number(s): 920985 8165490-UT <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 L UNLEADED 2.PREMIUM 3.DIESEL 4 <br /> Number,Stored Product) <br /> Bucket Installation 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): 9:00 am 9:00 am 9:00 am <br /> Initial Reading(Rl): 14.25" 14.50" 13.75" <br /> Test End Time(Tf): 10:00 am 10:00 am 10:00 am <br /> Final Reading(Rt): 14.25" 14.50" 13.75" <br /> Test Duration(Tf—Tl): IHR IHR 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 information on repairs made prior to testing.and recommended follow-up for failed tests) <br /> (cation of Technician Responsible for Conducting This Testing <br /> I hereby certify that the in rmation ' this report is true,and in full compliance with legal requirements. <br /> Technician's Signat e: Date: 11/18/2014 <br />