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3EGElyfrp <br />anuary 2006 <br />Spill Bucket Testing Report Form APR 0 9 2015 <br />This form is intended for use by contractors performing annual testing of UST spill conta' ted form and <br />printouts from tests (f applicable), should be provided to the facility owner/operator for s�[@b1th�ry agency. <br />IgFA7Y "r-0 7�U N.T <br />I- FACIi.ITV INFORMATION <br />Facility Name: VELLAGE WEST MARINA Date of Testing: 03-16-2015 <br />Facility Address: 6649 EMBARCADERO DRIVE, STOCKTON, CA 95219 <br />Facility Contact: TIM FONTAINE I Phone: (209) 951-1551 <br />Date Local Agency Was Notified of Testing: 03-12-2015 <br />Name of Local Agency Inspector (f present during testing): FATINAH ZAREEF <br />7_ TF.cTYNG CONTRACTOR INFORMATION <br />Company Name: KAISER COMMERCIAL PETROLEUM <br />Technician Conducting Test: GREG KAISER <br />Credentials': ® CSLB Contractor ® ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Specify) <br />License Number(s): CSLB No. 859535, ICC No. 5252318 <br />3 SPILL BUCKET TESTING INFORMATION <br />❑ Vacuum ❑ Other <br />Test Method Used:tH70, <br />Test Equipment Use <br />Equipment Resolution: 1/32 <br />Identify Spill Bucke2 <br />Number, Stored Pro <br />1 <br />tE <br />DIESEL 2 <br />3 <br />4 <br />Bucket Installation T <br />um <br />® Direct Bury <br />0 Contained in Sum <br />❑ Direct Bury <br />❑ Contained in S <br />❑ Direct Bury <br />❑Contained in SumBucket <br />Diameter:11 <br />Bucket Depth:13 <br />V2 <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TO: <br />9:00 <br />9:00 <br />Initial Reading (&): 1 <br />14% <br />13" <br />Test End Time (TF): <br />10:00 <br />10:00 <br />Final Reading (RF): <br />14% <br />13" <br />Test Duration (TF — T): <br />1 HOUR <br />1 HOUR <br />Change in Reading (RF - R,): <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />PASS <br />PASS <br />Test Result: <br />® Pass []Fail <br />N Pass ❑ Fail <br />❑ Pass []Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to 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 requirements. <br />Technician's <br />Date: 03-16-2015 <br />' State laws and regulations dq� t currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. �/ <br />