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9255517888 Une1 • :11:20 10-12-2012 616 <br /> ®6EITIER-RYAN INC. GR JOB# 20-581987 <br /> 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 from tests Of applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> FacilityName: PG&E Date of Testing: 9/28/2012 <br /> Facility Address: 4040 West Lane,Stockton,CA <br /> Facility Contact: - Phone: <br /> Date Local AgencyWas Notified of Testing: 8/10/2012 <br /> ame o oca Agency ospector i present during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Get tler-Ryan Inc„6747 Sierra Court Suite J,Dublin,C.a.94568 P10925-551-7555 <br /> Technician Conducting Test: Wes Morrison <br /> Credentials:(1) CSLB Contractor ICC service Tech. SWRCB Tank Tester Other(Spec) <br /> License Number: 220793 ICC Tech Number: <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hvdrustatic Vacuum Other <br /> Test Equipment Used: Lake'lest Equipment Resolution: 1/16" <br /> Idenfify Spill Bucket(By Tank 1 Diesel 2 Gas 3 Waste Oil 4 <br /> Number,Stored Product,etc. <br /> Bucket Installation Type: x 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: 11" Il" Ill, <br /> Bucket Depth: 13" 14" 13.5" <br /> Wait time between applying <br /> vacuum/water and start of test: 15 min. IS min. IS min. <br /> Test Start Time(Ti): 11.:55 AM 9:25 AM 9:25 AM <br /> Initial Reading(Ri): 12" 121/4" 111/2" <br /> Test End Time(Tf): 12:55 PM 12:55 PM 12:55 PM <br /> Final Reading(Rt) i2" 121/4" 111/2" <br /> Test duration(If-Ti): I hr. 1 hr. I hr. <br /> Change in Reading(Rf-Ri): 0 0 0 <br /> Pass/Fail Thhold or Criteria: 0 0 " ' 0 0 <br /> Test Resultress: Pass Fail Pn3s Fail 1 `Pass Fail .` Pass. Fail <br /> Comments-(include information on repairs made prior to testing.and recommendedfollow-up for failed tests) <br /> Diesel had leaking cap and drain valve was dirty. <br /> CERTFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> !hereby certify that all the information contained in this report Is true,accurate,and in full compliance with legal requirements <br /> Technician's Signature: Wes Morrison Date: 9/28/2012 <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 />