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C31, 1, gu n " 4 5� �:�1 �I•r; ,� Ilt Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures: 1W completed foifii. Fi printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: YRC Freight #813 Date of Testing: 02/01/2018 Facility Address: 1535 E. Pescadero Avenue Facility Contact: Ruben Phone: (913) 344-3644 Date Local Agency Was Notified of Testing: 1/19/2018 Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Confidence UST Services, Inc. Technician Conducting Test: Aaron Perrigo Credentials': ❑X CSLB Contractor X ICC Service Tech. SWRCB Tank Tester L -I Other (Spec) License Number(s): CSLB# 804904 ICC# 8485827 -UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: N Hydrostatic ❑ Vacuum Other Test Equipment Used: Lake Test Equipment Resolution: 0.0625" Identity Spill Bucket (By Tank A4nnber, Stored Product, etc. I Waste oil 2 3 4 Bucket Installation Type: ❑x Direct Bury []Contained in Sum ❑Direct Bury []Contained in Sump []Direct Bury ❑Contained in Sum ❑Direct Bury []Contained in Sump Bucket Diameter: 12.00" Bucket Depth: 13.00" Wait time between applying vacuum/water and start of test: 5 min Test Start Time (T,): 9:00 am Initial Reading (R J: 10.75" Test End Time (TF): 10:00 am Final Reading (RF): 10.75" Test Duration (TF — Tr): 1 hr Change in Reading (RF- R,): 0.00" Pass/Fail Threshold or Criteria: 0.0625" Test Result: ❑x Pass []Fail ❑ Pass []Fail ❑ Pass ❑Fail ❑ Pass ❑Fail COMMent9 — (include information on repairs made prior to testing, and recommended follow-up for, failed tests) CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Ka Date: 02/01/2018 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.