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+ • SWRCB,January 2006 <br /> 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 /> printouts om tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Nie: Systems Transport I Date of Testing: May 30,2008 <br /> Facility Address: 707 E. Roth Road,French Camp,CA 95231 <br /> Facility Contact: Steve Tucker Phone: 209.983.8654 <br /> Date Loca Agency Was Notified of Testing : May 23,2008 <br /> Name of I ocal Agency Inspector(ifpresent during testing): Muniappa Naidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: STOCKTON SERVICE STATION EQUIPMENT CO. INC. <br /> Technici Conducting Test: Eric Molgaard <br /> Credential ': ❑CSLB Contractor (x)ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License N ber(s): ICC 5250200-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Meth)d Used: (x)Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc. DIESEL TANK <br /> Bucket Installation Type: x Direct Bury ❑Direct Bury ❑Direct Bury [I Direct Bury <br /> ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 13 INCH <br /> Bucket Depth: 10-1/2 INCH <br /> Wait time(between applying 5 MIN. <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 2:15 p.m. <br /> Initial Reading(Rj): 9-3/4 INCH <br /> Test End Time(TF): 3:15 p.m. <br /> Final Reading(RF): 9-3/4 INCH <br /> Test Duration(TF—Tj): 1 HOUR <br /> Change ini Reading(RF-Rt): -0- <br /> Pass/Fail hreshold or > 1/16 inch <br /> Criteria: <br /> Test RcsuR (X) 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 /> BUCKET LEAKING AT DRAIN VALVE. REMOVED VALVE AND CLEANED. REPLACED <br /> VALVE AND RETESTED BUCKET,NOW PASSING TEST. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> hereby cert that all the information contained in this report is true, accurate, and in full compliance with legal requirements. <br /> Technic' 's Signature: Eric Nolgaard Date: May 30,2008 <br /> State law and regulations do not currently require testing to be performed by a qualified contractor.However, local requirements <br /> maybe in re stringent. <br /> Page 4 of 4 <br />