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Afforda-Te$t Spill Bucket <br />416 2nd Street 209 744-01.12 Test Report <br />Galt, Ca. 95632 FAX 209 744-0116 p <br />1. FACILITY INFORMATION <br />Facility Name: �(( fl. o teEE L.At re- S v'c-- JDate of Testing: <br />Facility Address: 1700 e gyp( (�;, <br />Facility Contact: <br />/ Phone: IPO f- <br />Date Local Agency Was Notified of Testing :- <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name:r_,e'C A. -7-e; <br />Technician Conducting Test:, <br />Credentials: ❑ CSLB Contractor Aicc Service Tech. KSWRCB Tank Tester ❑ Other (Spec) <br />License Numher(s):—r <br />3. , SPILL BUCKET TESTING INFORMATION <br />Test Method Used: VHydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: <br />quipment Resolution: V1 I.= " <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 <br />c..._� -7 <br />2 <br />`' `�^ <br />7; <br />3 <br />4 <br />1 <br />Bucket Installation Type: <br />D -Di ect Bury <br />❑ Contained in Sump <br />,6 -Direct Bury <br />❑ Contained in Sump <br />,p -Direct Bury <br />❑ Contained in Sump <br />Q -Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />( <br />l' <br />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test: <br />------ <br />Test Start Time (T,): <br />3 tj <br />1 b1+5 <br />Initial Reading (RO: <br />3 <br />0 <br />� i %-- <br />� � <br />Test End Time (TF): <br />14 4 p <br />I � � <br />� � t� C� <br />� <br />Final Reading (RF): <br />1 l�� <br />t <br />Test Duration (TF — TI): <br />#. <br />Change in Reading (RF - RI): <br />—�---- <br />Pass/Fail Threshold or <br />Criteria: <br />Test' Result � �t; ,�� 3 { , <br />S ,' - <br />Pass - °C7 Fail <br />-' Pass ❑Fail' <br />Pass ❑ Fail <br />s <br />Pass a Fail <br />Comments — (include informatic'n A repairs'made prior tol testing, and recommended follow-up for failed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal equirements. <br />Technician's Signature: Date: # i 1 <br />c <br />