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P.O.Box 4208 <br /> Sonora CA 95370 <br /> A ��� ���� � <br /> Ca:623541 A-Haz <br /> OCT _ i ; "i Phone:209-532-7320 <br /> Compliance without Compromise Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> wwwAltechpetro.com <br /> Vapor Spill Bucket Testing Report Form <br /> FACILITY INFORMATION: <br /> Facility Name: Costco #658 Tracy Date of Testing: September 21, 2017 <br /> Facility Address: 3240 W. Grrant Line Rd Tracy CA <br /> Facility Contact: Tony Haggard Phone: 209-834-1427 <br /> Notification Date of Local Agency: 9/15/2017 <br /> Name of Local Agency Inspector: John Alaniz <br /> SPILL BUCKET TESTING INFORMATION: <br /> Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used: 1-Hour Observed Test Equipment Resolution: 1/16" <br /> Identify Spill Bucket 1 87A Vapor 2 $76 Vapor 3 91 Vapor 4 Additive Aux <br /> Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury <br /> ® In Sump In Sump In Sump In Sum <br /> Wait time between <br /> applying vacuum/water None None None None <br /> and start of test: <br /> Test Start Time (T,): 9:00 am 9:00 am 9:00 am 9:00 am <br /> Initial Reading (R): Above Cap Above Cap Above Cap Above Cap <br /> Test End Time (TF): 10:00 am 10:00 am 10:00 am 10:00 am <br /> Final Reading (RF): Above Cap Above Cap Above Cap Above Cap <br /> Test Duration (TF—T,): 1.0 Hr. 1.0 Hr. 1.0 Hr. 1.0 Hr. <br /> Change in Reading (RF-R,): 0.0 0.0 0.0 0.0 <br /> Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" <br /> Criteria: <br /> Test Result: I ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail ® Pass ❑ Fail <br /> Comments — (include information on repairs made prior to testing, and recommended follow-up for failed <br /> tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> l hereby certify that all the information contained in this report is true, accurate, and in full compliance with <br /> legal requirements. <br /> Technician's Signature: , Date: 09/21/17 <br />