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09/18/2014 06:37 120933'-,73 FLAGCITY CHEVRON PAGE 07/07 <br />r'a9e fir <br />0911512014 1156 <br />SWRCB, January 2004 <br />Spill Bucket Testing Report Form <br />�rttozr#s s role rise f fuse <br />by co hrn11d bR n rre�d d to the fac T iy oN,ler/ope_jorfWSPiR o rsubm ttal o inment the local eS,t gultltoly agency. contpletadjbrm and <br />pn f <br />1. F'ACI:LITY INFORMATION <br />Facility Name: <br />FLAC: Cl'Ty CI-IEVRON Date of Testin : 09-04 13 <br />Facility Address', 647,1 CAPTTAL L ODI CALT'ORNIA <br />Phone•. 209-334.075 <br />Facility Contact; <br />KIU <br />Date J,mal Agency Was Notified of Testijg:8 B-13 ko:SAN 70AQUIN CO <br />Name of Local Agency Inspector (;f Present dui test <br />2, TESTING CONT R k,CTOR INFOitMATION <br />744-0112 Fax; (209) 744-0115 <br />Company Natne: AI FFORDA TEST x116 2!'' Street (Ttrlt, CA 95532 (209 ) <br />❑ Lyle D. Nimmo 0 7,ane A. Nimmo J3 David A, Winkler Lq I'alix 15. Rann,irez <br />Technician Conducting Test: 524911.5-13T 5263372-1 �T 526337347 5273934 -UT <br />Credentials" ® lCC Service Tech Ig SVd1ZCU Tank "1'ester <br />1'est Method Used: Ll YlyEonauc <br />Test uipment Used: TAPE 11:20 <br />Identify Spill Ruckot (By Tank 1 87 <br />Nwnber, So,ed l'ro't eta: <br />Ej Vacuum <br />jl Direct Bury <br />13ucket Installation Typc; <br />® Contained in, Sump <br />Bucket Diameter: <br />L 1 <br />Bucket aTth: <br />15 1./4 <br />Wait time between applying <br />vacuum/water and start of test; <br />Direct Bury <br />Test Start Time (TO: <br />1100 <br />Initial Reading (RQ: <br />14 <br />Test tn.d Timc (Tr); <br />1200 <br />Final Reading (R# <br />14 <br />Test Duration (TF — TO: <br />1, idOLTl:. <br />aiange in Reqding (RF- RD; <br />0 <br />1'ass/Fail "fhreshold or <br />0 <br />Ej Vacuum <br />UUIVJ <br />Ftquiprrlent Resolution: <br />1/lfi <br />2 87 <br />3 91 <br />4 DIE <br />Direct . <br />Direct Bury <br />j] Direct ;Bury <br />® Contained n <br />� Contained in. <br />® Contained in Sump <br />Srnl, <br />Sam a <br />14 <br />14 <br />151 /2 <br />1100 <br />1100 <br />14 <br />14 <br />1200 <br />1200 <br />W20O <br />14 <br />14 <br />1 IIOUR <br />1 1TOU'R0 <br />0 <br />0 <br />0 <br />Comments — include i onnad on on re ai,,s made ria, to sting, and rmcommemi'ed eller r roiled tests <br />CLRTiI [CATION OF'IlrCI1NlCI.AN 1tESFONSI-BLF, FOR CONDUCTING: THIS TE�S'1'INc* <br />I hereby certify that all the Information eontailted In this report Is trim. accurate, titer/ In'ittll conapllanmwith legal requirements, <br />' r;• -, Date; _!� 413_ <br />Technician's Signature;._ — �' <br />1 State law.;, nd regulations do not currently require testing to be performed by a qualified contractor. TIowever, local requirements <br />may be more I;tntfgent. <br />