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.� SWRCB, January 2006 Spill Bucket Testing Report Form This form s intended. for use by contractors performing annual testing of IJST spill containment structures. The completed form and printoutsom tests (!f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. I- FAC'TT.TTV TNFnRMATTnN Facility Naine: _ LOWER SAC CHEVRON Date of Testing: 12-30-09 _ Facility Address: 8660 LOWER SAC STOCKTON CA Facility Co tact: KAMAL Phone: Date Local gency Was Notified of Testing: Name of L cal Agency Inspector (if present during testing: GARRET i 2. TESTING CONTRACTOR INFORMATION Company +me: AFFORDA TEST 4162 nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 Technician onducting Test: ❑ Lyle D. Nimmo ❑ Zane A. Nimmo ® David A. Winkler ❑ Felix G. Ramirez 5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT Credentials : Z ICC Service Tech. Zi SWRCB Tank Tester 3. CPTT.T. RTTC'KFT'I .RTTNC, TNFnuMA'ranN Test Method Used: _ ® Hydrostatic ❑ Vacuum ❑ Other Test Equipment Used: h20 and tape measure Equipment Resolution: 1/16 Identify Spill Bucket (By Tank Number, Stored Product, etc.) 1 87 2 89 3 91 4 Bucket Installation Type: Yp Direct Bur ® Y F-1 Contained in Sump ®Direct Bury E] Contained in Sump ®Direct Bury El Contained in Sum ❑Direct Bury ❑ Contained in Sum Diameter: 1 1 l 1 11 _ Depth: 13 13 13 e b tween applyingwat rand start of test:rt Le T me (Ti): 930 930 930 ead ng (R,): 12 11.75 12 Ti e (TF): 1030 1030 1030 adi g (RF): 12 11.75 12 Test Durati n (TF — Tj): IHR IHR IHR Change in Reading (RF- Rj): 0 0 0 Pass/Fail Threshold or Criteria: 1/16 1%16 1/16 Test Result. Z Pass ❑ Fail Z Pass ❑ Fail Pass ❑ Fail ❑ Pass ❑ Fail —omment.r — (include information on repairs made prior to testing, and recommended follow-up for failed tests) CER I hereby eel CA 11UN UPTECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: T� Date 12-30-2009 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be m re stringent.