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Spill Bucket Testing Report Form <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printout from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Shell f Date of Testing: 10/15/2007 <br /> Facility Address: 3515 Navy Dr., Stockton <br /> Facility Contact: TOM EIKEMEIRER Facilit Phone: <br /> Date Local Agency Was Notified of Testing: 10/10/2007 <br /> Name of Local Agency Inspector if present during testing): RAY VON FLUE-SAN JOAQUIN COUNTY HEALTH <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test: MICHAEL L. STRAWN II <br /> Credentials: ®CSLB Contractor ®ICC Service ❑SWRCB Tank <br /> Tech Tester ❑Other(Specify) <br /> License Number(s):A ASB HAZB C-10; 588098 <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: INCON YS-STS I Equipment Resolution: .0006 <br /> Identify Spill Bucket(By Tank Number,Stored Product,etc) 1 RECLAIM 2 3 4I <br /> TANK <br /> ®Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Type ❑Contained in ❑Contained in ❑Contained in ❑Contained in <br /> Sump Sump Sump Sump <br /> Bucket Diameter inches 12 INCHES <br /> Bucket Depth inches 11 INCHES <br /> Wait Time between applying vacuum/water 15 MINUTES <br /> and start of test <br /> Test Start Time: 9:04 9:20 <br /> Initial Reading Ri): 6.5019 6.5021 <br /> Test End Time: 9:19 9:35 <br /> Final Reading Rf): 6.5021 6.5018 <br /> Test Duration: 15 Min 15 Min <br /> Chan a in Readin Rf-Ri : .0002 .0003 <br /> PasslFail Threshold or Criteria: .002 .002 <br /> Test Result Pass <br /> Comments: *ALL HYDROSTATIC TEST WATER WAS DROPPED/PUMPED INTO THE UNDERGROUND RECLAIM <br /> TANK PER SHELL PERSONAL. NO TEST FLUID WAS REMOVED FROM SITE. <br /> *SPILL BUCKET PASSED-NO REPAIRS ARE NEEDED AT THE PRESENT TIME. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate and in full compliance with legal requirements <br /> Technician's Signature Date 10/15/2007 <br />