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' 9. Spill Bucket Testing Report orm SWRCB,January 2006 This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests(f applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION FacilityName: ARCO # 06020, CC 18022765 DateofTesting: 09/12/2008 Facility Address: 1711 E YOSEMITE , MANTECA, CA, 95336 Facility Contact: MANAGER I Phone: (2 0 9) 823-4715 Date Local Agency Was Notified of Testing: 09/02/2008 Name of Local Agency Inspector(if present during testing): MUNIAPPA NAIDU 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: JOEY MESA Credentials I: ❑CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester E Other(Spec) ICC SERVICE License Number: 5259458-UT 3. SPILL BUCKET TESTING INFORMATION Test Method Used: X❑ Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: TAPE MEASURE Equipment Resolution:VISUAL LOSS Identify Spill Bucket(By Tank I 1 UNL FILL Z 2 MID FILL 3 3 PRE FILL 4 Number, Stored Product, etc.) ❑ Bucket Installation Type: Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑% Contained in SumpX❑Contained in Sump ❑% Contained in Sump ❑Contained in Sump Bucket Diameter: 11 1/211 11 1/211 11 1/211 Bucket Depth: 12 1/211 12 1/211 12 1/211 Wait time between applying 5 MIN. 5 MIN. 5 MIN. vacuum/water and starting test: Test Start Time(TI ): 9:0 0 9:0 0 10:2 5 Initial Reading(RI ): 11 1/211 11 1/2" it 1/2" Test End Time(TF): 10:05 10:05 11:35 Final Reading(R F ): 11 1/2" 11 1/2" 11 1/2" Test Duration: 60 MIN. 60 MIN. 60 MIN. Change in Readin (R F-RI ): 0" 0" 0" Pass/Fail Threshold or VISUAL LOSS VISUAL LOSS VISUAL LOSS Criteria: Test Result: Pass 0 Fail Pass 1:1 Fail Pass [:] Fail Pass Fail Comments- (include information on repairs made prior to testing, and recommended follow-zip for failed tests) 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 Signature: Z. l�..� Date: 09/12/2008 I State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements may be more stringent.