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SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> This form is intended for use by contractors p erftesting <br /> d to the facility owner/operator for containment structures. l <br /> submittal to the local regulatory ager Y nd <br /> printouts from tests (if applicable), should b provide <br /> 1.FACILITY INFORMATION <br /> Facility Na777 <br /> O <br /> Date of Testing: 3-28-17 <br /> Facility AdAIN ST MANTECA CA <br /> Facility Co <br /> Phone: <br /> Date Local Testing:3-7-17 ' <br /> resent durin testin AARON <br /> Name of Local Agency Inspector(if p g g� <br /> 2.TESTING CONTRACTOR INFORMATION I / RONMENTAL °'—iH <br /> 209 744-0112 Fax-,�09) <br /> Company Name: AFFORDA TEST 416 2°d Street Galt,CA 95632 ( ) <br /> ❑Ed Stearns ❑ Zane A.Nimmo ® David A.Winkler ❑ Fel 3934RG. amirez <br /> Technician Conducting Test: 8184188 5263322-UT 5263373-UT <br /> Credentials': ® ICC Service Tech. SWRCB Tank Tester <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Hydrostatic ❑Vacuum E] Other <br /> Test Method Used: ® H y Equipment Resolution: 1/16 <br /> Test Equipment Used: h20 and tape measure a <br /> 2 <br /> 4 <br /> Identify Spill Bucket(By Tank 1 87 91 3 89 <br /> Number, Stored Product, etc.) ❑ Direct Bury Direct Bury <br /> Direct Bury ❑ Contained in <br /> Direct Bury ❑ ®Contained in <br /> Bucket Installation Type: ® Contained in Sump ® Contained in Sump Sum Sum <br /> 11 11 <br /> Bucket Diameter: 11 14 <br /> Bucket Depth. 14 14 <br /> ° Wait time between applying - -- -- <br /> vacuum/water and start of test: 1 1 I <br /> Test Start Time(Ti): 13 <br /> 13 13.50 <br /> Initial Reading(RI): 2 <br /> 2 <br /> Test End Time(TF): 2 13.50 13 <br /> Final Reading(RF): 13 HR IHR IHR <br /> Test Duration(TF—Tj): 1 0 <br /> Change in Reading(RF-Ri): <br /> 0 0 <br /> Pass/Fail Threshold or 1/16 1/16 1/16 <br /> Criteria: ® pass ❑Fail ® Pass ❑Fail 9 Pass ❑Fail C] Pass <br /> Fail <br /> Test Result: <br /> w-up for failed tests) <br /> Comments— (include information on repairs made prior to testing, and recommended follo <br /> OPW <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDtiCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Date 3-28-17 <br /> Technician's Signature: <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 />