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Will Bucket Testing Report Form <br /> This form is intendedfar use by contractors performing annual testing of USTspi/l containment structures. The completed form and <br /> printoutsfrom tests(if applicable),should be provided to the facility owner/operatorfor submittal to the local regulatory agency. <br /> FACILITY INFORMATION Facility ID: 01 <br /> Facility Name: Shell Oil Products Date of Testing:9/29/2014 <br /> Facility Address: 3515 Navy Dr., Stockton, CA 95203 <br /> Facility Contact: Miguel Tones Phone: <br /> Date Local Agency Was Notified of Testing 2014-09-19 <br /> OCT 16 201 <br /> Name of Local Agency Inspector(ifpresent during testing): Michelle Henry <br /> TESTING CONTRACTOR INFORMATION �L-I-H <br /> [Technician <br /> ompany Name: TAIT Environmental Services,Inc. (_'." Ari I AI <br /> Conducting Test: Victor Guerrero <br /> edential' : r CSLB Contractor r ICC Service Tech r SWRCB Tank Tester r Other(Specify) <br /> cense number(s): A B ASB C-10 HAZ License Number 588098 : 8017001-UT <br /> SPILL BUCKET TESTING INFORMATION <br /> TestMethod Used: FHydrostatic FVacuum r Other <br /> Test Equipment Used: Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank <br /> Number,Stored Product,etc.) 1 Slop Tank <br /> Bucket Installation Type: F Direct Bury r Direct Bury r Direct Bu <br /> ry r Direct Bury <br /> F Contained in Sump r Contained in Sump r Contained in Sump r Contained in Sump <br /> F On top of AST r On top of AST r On top of AST r On top of AST <br /> Bucket Diameter: II" <br /> Bucket Depth: 11" <br /> Wait time between applying <br /> vacuum/water and start of test: 15 min. <br /> Test Start Time(Tl): 9:30 am <br /> Initial Reading(RI): 9.75" <br /> Test End Time(TF): 10:30 am <br /> Final Reading(RF): 9.75" <br /> Test Duration(TF—Tl): 1 hour <br /> Change in Reading(RF-Rl): 0 <br /> Pass/Fail Threshold or 0 <br /> Criteria: <br /> Test Result: I r Pass r Fail r Pass r Fail r Pass F Fail r Pass r Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test water put into slop tank. <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: / _,'y,: / ._- _.�1_ Date: 9/29/2014 <br />