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SWRCB, January 2006 <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: Unocal Date of Testing: 7/13/12 <br />Facility address: 2701 March Ln. Stockton, CA 95219 <br />Facility contact: Darren Eppler (209) 473-7337 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency inspector (If present during testing): Garrett Backus <br />12 sce'rrwr- rnwr0Af'Tf%0 IN9:nRM®T1nN <br />Company Name:Service Station Systems <br />Technician Conducting Test: Ryan Case <br />Credentialst : ® CSLB Contractor ® ICC Service Tech. ❑ SWRCB Tants Tester ❑ Other (Specify) <br />License Number(s): License: 485184 ICC:8057554-UT <br />3. SPILL BUCKET TESTING fIVFORMATION <br />Test Method Used: <br />® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Measuring Tape Equipment Resolution:1/16 in. <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />.a. .. , �P , .,.. . ,. ,. 7 7777777,11 <br />1 Fill Bucket <br />Q?. LgMivr% <br />Bucket Installation Type: <br />® Direct Bury <br />❑ Contained in Sump <br />Bucket Diameter. <br />13.00 in. <br />Bucket Depth: <br />13.19 in. <br />Wait time between applying <br />vacuumtwater and start of test: <br />15 min. <br />Test Start Time (TI }: <br />11:00am <br />Initial Reading ff� ): <br />12.063 in. <br />Test End Time (TF ): <br />12:00pm <br />Final Reading (Pp }: <br />12.063 in. <br />Test Duration (TF - T j): <br />1.00 hr. <br />Change in Reading (RF - R1): <br />0.0000 in. <br />PassiFail Threshold or criteria: <br />ZERO LOSS <br />; <br />.■y!�st Rtascdt. .... Pis L <br />!' Y <br />Comments: 91 Fill Bucket Tested after Bucket Replacement. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the Information contained in this report Is true, accurste and In tint compliance with legal requirements. <br />/� �% Z - Date 7/13/12 <br />Technician's Signature: <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />