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r.14 <br />Spill Bucket Testing Report Form <br />1. <br />FACILITY INF+�IRMATI4N <br />Y^acility Name: 1+LAG CITY CHEVRON <br />Date of Testing: 9/2812012 <br />Facility, Address: 6421 CAPITAL LODI CA, 95ld! <br />FadlityContaot: PAT MURALL <br />Date Local Agency was notified of Testing; 09/04/2012 phone: 530-78$_2276 <br />Name of Local Agency Inspector (ifpresent during testing;) ARTS ~"— <br />Company Name: A7id Valley Consultin & General E �� 11 �VtY� �lluly <br />8 ngincering <br />Technician Conducting Test: James bay <br />Credentials; CSI,$ Canfraetor TCC Service Tech. <br />LicenseNumbcr(a): 920985 S'RCB Ihnlctester <br />873644,UT <br />1. SPTI,LBt1CxCET i'E,STING INFORMATION <br />[Test lYletltod Ua — IIy_ drostAtic 'Vacuum Other <br />IostEg lipmentUsed: Pump <br />Equipment Resolution: <br />Identify Spill Bucket (By Tank 1. SUPER2. UNLEADE, D <br />Number, Stored Product) 3• UNLEADED <br />4. DIESIJL <br />MASTER SLAVE <br />Bucket 1nsi lltion TSTc; Direct Burly Direct Bury Dirept <br />BKCont4;ned in Sump X Contained in Sump Wontaned inSum p <br />Bucket Diameter: <br />� irect Bury <br />Contained in Sump <br />12*' 12" 12" <br />Bucket Depth. <br />12" <br />17.50" 17.25°• <br />17.75" <br />Vl�alt time between applying 10 MIN <br />17 25" <br />10 MIN <br />vacuum/water and start of test: 10 MIN <br />10 MIN <br />Test Start Time (Tl): 9:19 AM 9:15 AM <br />Initial Reading (RI); 9:15 AM 14.50" <br />--------- 9:15 AM <br />If.25" <br />Test End Time (Tt): 16.75" <br />10;15 ANT <br />16,25" <br />14:15 AM <br />Final Reading (Rfj; 10:15 A -NJ <br />16,34" <br />10:1.5,x,1 <br />4,50" 16.75" <br />Test Duration (Tf, T1); 1 IIIc <br />1.6.29' <br />1 I4R 1 <br />Change in Reading (Rf Rl): 0 <br />i HR <br />11, 75 " 0 <br />0 <br />Pass/Fail Threshold or Criteria: <br />0 <br />0 <br />.0251'.025" <br />_ 023" <br />Test Results: X Pass FAi1 Pass X Fain XFass <br />.025" <br />l4'$iI XI'ass Fail <br />mati on irs de rinr to t s 'n a re me ded f flour_ for 'led t qts <br />Certif ution of Technician Responsible for Conducting This Testing <br />I hereby certify that all the in ' <br />a in this report is true, and in full compli0nce with legal requirements. <br />_ Technician's $ignaffrre: <br />UAte• 0 I2S/�pI2 <br />