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9255517888 Line 1 :46 a.m. 12-01-2009 2/12 <br /> ` Spiaucket Testing Report For9 <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(fapplicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: PG&E Date of Testing: 11/18/09 <br /> Facility Address: 4040 West Lane, Stockton Ca <br /> Facility Contact: Michelle Le Phone: <br /> Date Local Agency Was Notified of Testing: 11/2109 <br /> Name of Local Agency Inspector(#present during testing): Garret Backus <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-Ryan Inc. <br /> Technician Conducting Test: Joe Serna 5259492-UT <br /> Credentialsi: t::CSLB Contractor X ICC Service Tech. 0 SWRCB Tank Tester 0 Other(Specify) <br /> License Number(s): 220793 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic 0 Vacuum 0 Other <br /> Test Equipment Used: Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 -Unleaded 2-Diesel 3-Waste Oil 4 <br /> Number,Stored Product, etc <br /> Bucket Installation Type: X Direct Btuy X Direct Bury X Direct Bury 0 Direct Bury <br /> 0 Contained in Sump 0 Contained in Sump 0 Contained in Sump 0 Contained in Sum <br /> Bucket Diameter. 12" 12" 12" <br /> Bucket Depth: 14" 12" 12 3/4" <br /> Wart time between applying jlinin 2min Imin <br /> vacuum/water and start of test <br /> Test Start Time(Tr): 10:27am 10:48am 10:28am <br /> Initial Reading(Ri): 13 3/8" 113/8" 12 1/4" <br /> Test End Time(TF): 11:30am Fail 11:30 <br /> Final Reading(RF): 13 318" 12 I/4" <br /> Test Duration(TF-TO: lhr /3min Ihr/2min <br /> Change in Reading(RF-RI): 0 0 <br /> Pass/Fail Threshold or 0 0 <br /> Criteria: <br /> Teat Result: X Pass 0 Fail 0 Pass 0 Fail X Pass 0 Fail 0 Pass 0 Fail <br /> Comments—(include information on repairs made prior to testing, and recommendedfollow-up for failed tests) <br /> Troubleshoot diesel bucket replace drain valve tighten loose adaptor. Retest still <br /> Failed. Body of bucket pushed out at base of bucket. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> 1 hereby cert fy that all the information contained In this report is true, accurate,and in full compliance with legal requirements. <br /> Technician's Signature:; t A1611 Dater <br /> F <br /> State laws and regulationwo not currently require testing to be performed by a qualified contractor.However,local requirements <br /> may hp m.ra etrinormt <br />