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9255517888 Une 1 11:39:33 09-24-2013 6/12 <br /> 196frT1fR-RYAN INC. • � tob# 20-692178 <br /> SEP 24 2013 SWRCB,January 2006 <br /> Spill Bucket Testing Report FE9o $ ,i'' NTAL <br /> This form is intended for use by contractors performing annual testing of UST spill contjgMgLn(?gt0"aM-tTVteN(Tampleted form and <br /> printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> FacilityName: PG&E Dale of Testing: 9/18/20I3 <br /> Facility Address: 4040 West Lane.,Stockton <br /> Facility Contact: Phone: <br /> Date Lncal Agency Was Notified of Testing: 8/19/2013 <br /> Name of Local Agency Inspector i present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc.,6747 Sierra Court Suite J.Dublin,Co.94568 P10925-551-7555 <br /> Technician Conducting Test: .lose Carraseo <br /> Credentials:(1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number: 220793 ICC Tech Number: 5322633-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: livdrostatic vacuum Other <br /> Test Equipment Used: Standard Tape Measurer Equipment Resolution: 1116" <br /> Identify Spill Bucket(By Tank 1 Unleaded Fill 2 Diesel Fill 3 Waste Oil Fill 4 <br /> Number,Stored Product,etc. <br /> Bucket Installation Type: .Direct Bury X Direct Bury X Direct Bury Direct Bury <br /> Contained in Sump Contained in Sump Contained in Sump Contained in Sump <br /> Bucket Diameter: 12" 12" 12" <br /> Bucket Depth: 13.5" 13" 13" <br /> Wait time between applying <br /> IOmin IOmin lOmin <br /> vacuum/water and start of[es[: <br /> Test Start Time(Ti): 11:00 AM 11:00 9:00 <br /> Initial Reading(Ri): 12114" 11.5" 113/4" <br /> Test End Time(TO: 12:00 PM 12:00 10:00 <br /> Final Reading(Rf) 121/4" 11.5" 113/4" <br /> Test duration(Tf-Ti): Ihr ilr the <br /> Change in Reading(Rf-Ri): 0 0 0 <br /> Pass/Fail Threshold or Criteria: 0 0 0 0 <br /> Test Results: X Pass :Fill;, 'Pass Fail X Pass Fail :Pass Fail <br /> Comments-(include information on repairs made prior to testing,and recommended follow-up for failed tests) <br /> CERTFICATION OF TECIINICLIN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby cerrify that all the ini ormafron contained In this report is true,accurate,and in full compliance with legal requirements <br /> Technician's Signature: Date: 91188013 <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 />