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SWRCB,Janu <br /> Spill Bucket Testing Report Form APR (' 71 2018 <br /> This form is intendedfor use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Village West Marina I Date of Testing: 3/6/2018 <br /> Facility Address: 6649 Embarcadero Drive Stockton,CA 95219 <br /> Facility Contact: Tim Fontiane I Phone: (209)640-3556 <br /> Date Local Agency Was Notified of Testing: 3/2/2018 <br /> Name of Local Agency Inspector(if present during testing): Aaron Hang <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Diamond Petroleum Services Inc. <br /> Technician Conducting Test: Guadalupe Sanchez <br /> Credentials': x CSLB Contractor x ICC Service Tech. F SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): 1005444 5250451 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: xi-lydrostatic VaCHL1111 ❑Other <br /> Test Equipment Used: Standard Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 TI: Diesel Fill 2T2: 91 Fill 3 T3: 4 T4: <br /> Number, Stored Product, etc.) <br /> Bucket Installation Type: x Direct Bury x Direct Bury Direct Bury Direct Bury <br /> Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 12" 12" <br /> Bucket Depth: 13 7/8" 16" <br /> Wait time between applying 1 minute 1 minute <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 9:15 a.m. 9:18 a.m. <br /> Initial Reading(RI): 13" 14 7/8" <br /> •Test End Time(TF): 10:15 a.m. 10:18 a.m. <br /> Final Reading(RF): 13" 14 7/8" <br /> Test Duration(TF—Ti): 1 hr I hr ` <br /> Change in Reading(RF-111): 0 0 <br /> Pass/Fail Threshold or 1116" L,16" <br /> Criteria: <br /> Test Result: x Pass ❑ Fail _ x Pass ❑Fail Pass ❑Fail Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-upforfailed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all lite information contained In this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's SignatuDate : 3!6!2018 <br /> ' State laws and regulations do not currently require testing to be performed by a qualified contractor. I lowever, local requirements <br /> may be more stringent. <br />