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OCT 2 0 swlc8,January 2006 <br /> Spill Bucket Testing Report Form `r n/�(���� <br /> This form is intended for use by contractors performing annual testing of UST spill contai�d6�Ii�Ri'�•1� �d form and <br /> printouts from tests (ifapplicable),should beprovided tothefacilityown erloperatorforsubAAFkTd-4hM9frl5g atoryagency. <br /> 1. FACILITY INFORMATION Facility ID: 01 <br /> Facility Name: Shell Oil Products Date of Testing: 2015-09-25 <br /> Facility Address: 3515 Navy Dr. Stockton CA 95203 <br /> Facility Contact: Miguel Torres Phone:916-371-6911 <br /> Date Local Agency Was Notified of Testing: 2015-09-22 <br /> Name of Local Agency Inspector(ifpresent during testing): Steel Rivera <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT Environmental Services <br /> Technician Conducting Test: Victor Guerrero <br /> Credentials: OCSLB Contractor El ICC Service Tech. ❑SWRCB Tank Tester [I Other(Spec) <br /> License Number(s): A B ASB C-10 RAZ,588098 8017001-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑x Hydrostatic []Vacuum ❑Other <br /> Test Equipment Used: Incon TS-STS Equipment Resolution: .0006 <br /> Identify Spill Bucket (By Tank I Slop Tank 2 3 4 <br /> Number, Stored Product, etc. <br /> [ODirect Bury []Direct Bury []Direct Bury []Direct Bury <br /> Bucket Installation Type: ❑Contained in Sump []Contained in Sump ❑Contained in Sump []Contained in Sump <br /> []On Top of AST []On Top of AST []On Top of AST []On Top of AST <br /> Bucket Diameter: 11" <br /> Bucket Depth: 11" <br /> Wait time between applying 15 min. <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 10:14 am 110:29 am <br /> Initial Reading(R,): 5.4136/5.4138 <br /> Test End Time(TF): 10:29 am/10:44 am <br /> Final Reading(RF): 5.4138/5.4135 <br /> Test Duration(TF—Tt): 15 min./15 min. <br /> Change in Reading(RF-Rj): .0002/.0003 <br /> Pass/Fail Threshold or .002/.002 <br /> Criteria: <br /> Test Result: E9 Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> All test water was left on site. <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: t/ar2 1"now Date: 2015-09-25 <br /> State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may be more stringent. <br />