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SWRCB,January 2006 <br /> 9. "1 Bucket Testing Repormuorm <br /> This form is intended for 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: CONOCO PHILLIPS #2705448 Date of Testing: 05/22/2007 <br /> Facility Address: 3202 W HAMMER LANE STOCKTON, CA, 95209 <br /> Facility Contact: MANAGER Phone: (2 0 9) 957-2 900 <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: TANKNOLOGY, INC. <br /> Technician Conducting Test: DOUG FALDE <br /> Credentials): ❑CSLB Contractor E]ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number: <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: El Hydrostatic ❑ Vacuum ❑ Other <br /> Test Equipment Used:WATER AND TAPE MEASURE Equipment Resolution: <br /> Identify Spill Bucket(By Tank F[o-- <br /> 2 PRE VAPOR 2 3 DIE FILL 3 3 DIE VAPOR 4 <br /> Number,Stored Product, etc.) <br /> Bucket Installation Type: <br /> Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter: 11.00 11.00 11.00 <br /> Bucket Depth: 14.50 14.00 12.00 <br /> Wait time between applying 5MIN 5MIN 5MIN <br /> vacuum/water and starting test: <br /> Test Start Time(TI ): 0 815 0 815 0 815 <br /> Initial Reading(RI ): 10.50 10.00 8.50 <br /> Test End Time(TF ): 0 915 0 915 0 915 <br /> Final Reading(RF ): 10.50 10.00 5.375 <br /> Test Duration: 1HR 1HR 1HR <br /> Change in Reading(R F-RI ): 0.00 0.00 3.125 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> MENEEMEMEEMEMEM <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 Signature: 7z2- 0Date: 05/22/2007 <br /> i State laws and regulations do not currently require testing to be performed by a qualified contractor.However,local requirements <br />