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SWRCB,January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: KJS ENTERPRISE Date of Testing: 3/27/08 Facility Address: 1100 S.Main St. Manteca Ca.95336 Facility Contact: Jessie Chadda I Phone: (209)825-6784 Date Local Agency Was Notified of Testing: 3/(`x/08 Name of Local Agency Inspector(if present during testing): Muni Naidu 2. TESTING CONTRACTOR INFORMATION Company RELIABLE PETROLEUM SERVICES INC. Technician Conducting Test: Guadalupe Sanchez Credentials: X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) License Number(s): 883706 5250451-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X Hydrostatic ❑Vacuum ❑Other Test Equipment Used: Standard Tape Measure Equipment Resolution: Identify Spill Bucket(By Tank Tl: Unleaded T1: Unleaded T2: Premium Fill T3: Plus Fill Number, Stored Product, etc. West Fill East Fill Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury X Contained in Sump X Contained in Sump X Contained in Sump Contained in Sum Bucket Diameter: 12" 12" 12" 12" Bucket Depth: 14'/" 15%" 15 3/8" 15'/:" Wait time between applying Imin. lmin. Imin. I min. vacuum/water and start of test: Test Start Time(Tj): 11:12 a.m 9:14 a.m 9:21a.m 11:10 a.m Initial Reading(Ri): 10'/:" 10 5/8" 10'/4" 10'/4" Test End Time(TF): 12:12 p.m 10:14 a.m 10:21 a.m 12:10 p.m Final Reading(RF): 10'/z" 10 5/8" 10%" 10%" Test Duration(TF—Ti): 1 hr. 1 hr. 1 h r. 1 hr. Change in Reading(RF-Ri): 0 0 0 0 Pass/Fail Threshold or 1/16" 1/16" 1/16" 1/16" Criteria: Test Result: X Pass Fail X Pass Fail X Pass Fail X Pass Fail Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) T 1 • West Fill & T3• Plus Fill failed test earlier & Repaired & Cleaned drain Valves & retested while on site with Inspector- both Spill Buckets passed CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. Technician's Signa�c• Date: 03/27/08 State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.