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Spill Bucket Testing Report Form <br />RECEIVED <br />SWRCB January 2006 <br />APR 09 2018 <br />This form is intended for use by contractors perforating annual testing of UST spill containment structuNA1 rm and <br />printouts front tests (if applicable), should be provided to the facility owner/operator for submittal togR: t r <br />FACILITY INFORMATION <br />Facility Name: ARP Mini Mart Mobil I Date of Testing: 1/8/2018 <br />Facility Address: 25775 So. Patterson Rd., Tracy, CA 95376 <br />Facility Contact: Neil Patel I Phone: (510) 299-1219 <br />Date Local Agency Was Notified of Testing: 2/28/2018 <br />Name of Local Agency inspector (if present during testing): Betty Ho <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Diamond Petroleum Services. Inc. <br />Technician Conducting Test: Guadalupe Sanchez <br />Credentials': x CSLB Contractor x ICC Service Tech. ❑ SWRCB Tank Tester :1 Other (Spech) <br />License Number(s): 1005444 5250451 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: xHvdrostatic = Vacuum Other <br />Test Equipment Used: Standard Tape Measure <br />Equipment Resolution: 1/ 16" <br />Identify Spill Bucket (B'v Tank <br />Number. Stared Product, etc.) I <br />1 Tl: 87 Slave Fill <br />2 T2: 87 Master Fill <br />3 T3: 87 Siphon <br />Fill <br />4 T4: 91 Fill <br />Bucket Installation Type: <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />x Contained in Sump <br />Direct Bury <br />x Contained in Sum <br />Bucket Diameter: <br />12" <br />12" <br />12" <br />12" <br />Bucket Depth: <br />17" <br />13'/4" <br />16'/4" <br />13'/4" <br />Wait time between applying <br />vacuum/water and start of test: <br />1 minute <br />1 minute <br />1 minute <br />1 minute <br />Test Start Time (T,): <br />10:52 a.m. <br />10:53 a.m. <br />10:53 a.m. <br />10:50 a.m. <br />initial Reading (Ri): <br />16 5/8" <br />12 7/8" <br />16" <br />123/4" <br />Test End Time (T,:): <br />11:52 a.m. <br />11:53 a.m. <br />11:53 a.m. <br />11:50 a.m. <br />Final Reading (RF): <br />16 5/8" <br />12 7/8" <br />16" <br />12 3/4" <br />Test Duration (TF — T,): <br />I hr <br />1 hr <br />I hr <br />l hr <br />Change in Reading (RF - R,): <br />0 <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />1/16" <br />1 / 16" <br />1/ 16" <br />1/ 16" <br />Test Result: <br />x Pass Fail <br />x Pass ❑ Fail <br />Pass x Fail <br />x Pass F1 Fail <br />Comments — (include information on repairs made prior to testing, and recommended foflow-up.lbr./ailed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained in this report is trite, accurate, and in full compliance with legal requirements. <br />Technician's SignatuDate : 3/8/2018 <br />' 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 />