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rria-RYAN INC. <br />GR Job # 20-643211 <br />S W RCB, 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 from tests (if applicable), should be provided to the facility ownerloperator for submittal to the local regulatory agency. <br />1 FAf II ITV 1NVrMMATVIN <br />Facility Name: Dart Container Corp. Date of Testi g: <br />acilityAddress: 1400 E. Victor Road, Lodi, CA <br />Facility Contact: Robert Vargas Phone: 209-333-8088 <br />Date Local Agency Was Notified of Testing: <br />ame of Localgencynspector i present during testing) <br />2. TESTING CONTRACTOR INFORMATION FNVIRnNhAFNT.°.i i-IFtlI TW <br />._.._...... <br />Company Name: Gettler-Ryan Inc., 6805 Sierra Court Suite(;, Dublin, Ca. 94568 Ph.# 925-551-7555 DEPARTMENT <br />Technician Conducting Test: Jose Carrasco <br />Credentials: (1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other (Spec) <br />License Number: 220793 ICC Tech Number: 5322633 -UT <br />3. SPILT. RUC.KF.T TESTING INF(IRMAT1nN <br />Test Method Used: <br />Hvdrustatic Vacuum <br />Other <br />Test Equipment Used: <br />Standard Tape Measurer <br />Equipment Resolution. <br />1/16" <br />Identify Spill Bucket (By lank <br />Number, Stored Product, etc. <br />I Diesel 2 <br />3 4 <br />Bucket Installation Type: <br />x Direct Bury Direct Bury <br />Contained in Sump Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Direct Bury <br />Contained in Sump <br />Bucket Diameter. <br />12" <br />Bucket Depth: <br />13.5" <br />Wait time between applying <br />vacuum water and start of test: <br />Smin <br />Test Start Time (Ti): <br />9:10 AM <br />Initial Reading (Ri): <br />12" <br />Test End Time (TB: <br />10:10 AM <br />Final Reading (RB <br />l2" <br />Test duration (Tf - Ti): <br />the <br />Change in Reading (Rf-Ri): <br />0 <br />Pass/Fail Threshold or Criteria: <br />0 0 <br />0 <br />0 <br />Test Results: <br />y Pass Fail I Pass Fail <br />Pass Fail <br />Pass Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up forfailed tests) <br />CERTFICATION 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: <br />Date: 12/9/2016 <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. <br />