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' SWRCB,January 2006 <br /> Spill Bucket Testing Report Form turay. The <br /> grin form is m m s"(rf r use by It!), steactors hould he p ovr'ded o the fac iannual ting qf ty owner/operator for ill containment <br /> ubmittal locthe local regulatory agenmy and <br /> printouts rem tests(rf app ' )• <br /> 1. FACILITY INFORMATION <br /> Facility N me: Systems Transport <br /> Date of Testing: May 19,2009 <br /> LDa <br /> dregs: 707 E•Roth Road,French Camp,CA 95231 Phone: 209.983.8654 ntact: 9tevc fuckerMay 6,2009 1 Agency Was NotifieogMichelle Henry <br /> oval Agdncy Inspectot(if present during roung): <br /> 2. TF <br /> STING CONTRACTOR INFORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPMENT CO. INC. <br /> Tcohnici Conducting Test: Mike Jones ec{ <br /> Credenti ls�: ❑CSLB Contractor (x)ICC Service Tech. ❑3WRCB Tank Tester o Other(Sp 'fY) <br /> License Uirlber(s): ICC 5254644•UT <br /> 3, SPILL BUCKET TESTING INFORMATION <br /> Hydrostatic )Vacuum 0 Other <br /> Test Me od Used: (x) y Equipment Resolution: <br /> Test Fqu pment Used: <br /> 0 Direct Bury 3 <br /> 4 <br /> xD 2 <br /> Identify pill Aucket(B,v Tank 1 <br /> Number,Stored Product, etc. DIESEL TANK H birect Bury H Direct Bury <br /> Direct Bury <br /> Bucket 1 stallatibn Type; Fj Contained in Sum ❑Contained in Sum ❑Contained in Sum ❑Contained in Sum <br /> Bucket iameter: 12 INCH <br /> BuckdtDepth: II INCH <br /> Wait ti a between applying 5 MIN. <br /> vactlurril water and start of test: <br /> Test Sta t Time(T): 9:28 a.m. <br /> Initial Reading(Rr): 11 INCH <br /> Test Fn 'Pima(Tr): 10:30 a.m. . <br /> Final Reading(RF): 11 INCH <br /> 1-est Dti mthin jr,—Ti): 1 HOUR <br /> Change in Reading(Rr.-Ri): -0- <br /> passlFa I Threshold or PASS <br /> criteria <br /> ..... (}F),,IP9$$:...OFeil (7 ass I7.Fai1 O,Pass„ Clb'ail CJ Pass, QFail <br /> CUtp Ctlt9- inulude i rmatton on repairs made prior to testing and recommendedfollow for failed tests) <br /> CERTTFICATiON OF TECHNICIAN RESipONSU1LE FOR CONDUCTING TIi� ce with legal requirements. <br /> 1 het edrttfy That till the inforntatien contained in this report is true,accurate,and fn fu1J compliance g 9 <br /> Tech ician's Signattire:.7rtik¢Jt»t¢s <br /> Date: May 19,2009 <br /> 1 State laws and regulations do not currently require testing to be performed by a qualified contractor.However, local requirements <br /> may be more stringent, Paec 4 or 4 <br />