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May 251608:54a • • P•1 <br /> w 9 <br /> Spill Bucket Testing Report Form MAY 2 5 2016 <br /> 1. FACILITY INFORMATION <br /> Facility Name: FASTAND EASY Date of Testing 41=016 r <br /> Facility Address: IOMN.HWY99 STOCTONCA, uFQt�y aiT Ya <br /> Facility Contact: MIKEALE Phone: <br /> Date Local Agency was notified of Testing: <br /> Name of Local Agency Inspector(if present during testing:) <br /> 2.TESTING CONTRACTOR INFROMATION <br /> Company Name:Mid Valley Consulting&Cenral Engineering <br /> Tecbnkian Conducting Test:JASON HAASE <br /> Credentials: CSLB Contractor ICC Service Teeb. SWRCB Tank tester <br /> License Number(s): 920985 8165409-UC <br /> 1. sPILLBUCKET TESTING INFORMATION <br /> Test Method Use: z Hydrostatic Vacuum Other <br /> Test Equipment Used: Pump Equipment Resolution' <br /> identify Spilt Bucket(BY Tank I.PREMHIM 2.PLUS 3.UNLEADED .DIESEL <br /> Number,Stored Product) <br /> Bucket Installation Type: X Direct Bury X Direct Bury X Direct Bury X Direct Bary <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" 12" <br /> BuckMDepth: 12" 12.75" 1250" 16" <br /> Wait time between applying 5 MIN 5 MLN 5 MIN 5 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 10:00 AM 10:00 AM 10:00 AM 10:00 AM <br /> Initial Reading(RI): 11" 11.75^ 1150" 15" <br /> Test End Time(Tf): I1:00 AM 11:00 AM 11:09 AM 11:OO AM <br /> -Final Reeding(Rt): 11" 11.75" 1150" 15„ <br /> Test Duration(Tf—T1): 1H IHR IHR IHR <br /> Change in Reading(Rf RI): 0 0 0 0 <br /> ptsslFail Threshold or Criteria: .025" .025" <br /> Test Resuks: X Pass Fail X Pass Fail X Pass Fail X Pass Fail <br /> Coumeots (include.it,fonnation on repairs made prior to testma.and recommended follo)I-up for failed te5M <br /> I hereby certify that all the information in this report is true,and in full compliance with legal requirements. <br /> Teehuicianrs Signature:__ Date: 4/252016 <br />