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APR -26-2012 09:18 Service Station Systems <br />0 10 <br />408 938 8888 P.02 <br />SWRCB. January 2006 <br />This fort 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 ownerloperator for Submittal to the local regulatory agency. <br />9 FACILITY INFARMATIAN <br />Facility Name: Unocal Date of Testing; 3/29/12 <br />Facility Address: 2701 March Ln. Stockton, CA 95219 <br />Facility contact: Darren E pler (209) 473-7337 <br />Date Local Agency Was Notified of Testing: 3/21/12 <br />Name of Local Agency Inspector (if present during tearing): <br />2_ TESTIN(. CONTRACTOR INFARMATIAN <br />Company Name: Service Station Systems <br />Technician Conducting Test: Randy Wilkerson <br />Credentlaisi: (�jX CSLB Contractor ® ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Specify) <br />License Number(s): License: 485184 ICC:5258560-UT <br />3_ SP11 I RLICKFT TESTING INFORMATION <br />Test Method Used: <br />® Hydrostatic <br />❑ vacuum <br />❑ Other <br />Test Equipment Used: Measuring Tape <br />Equipment Resolution:1/16 in. <br />Identify spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />1 Fill Bucket <br />01 Re u <br />2 Fill Bucket <br />02 Prem <br />3 Fill Bucket 4 <br />03 Diesel <br />Bucket Installation Type: <br />Direct Bury <br />[] Contained In Sump <br />® Direct Bury <br />❑ Contained in Sump <br />❑X Direct Bury ❑ Direct Bury <br />❑ Contained in Sump ❑ Contained in Sump <br />Bucket Diameter: <br />12.00 in. <br />12.00 in. <br />12.00 in. <br />Bucket Depth: <br />14.00 in. <br />14.00 in. <br />14.00 in. <br />Wait time between applying <br />vacuum/water and start of test: <br />5 min. <br />5 min. <br />5 min. <br />Test Start Time (T, ): <br />10.00am <br />10:00am <br />10:00am <br />Initial Reading (R, ): <br />13.000 in. <br />13.000 in. <br />13.250 in. <br />Test End Time (Tp ): <br />11:00am <br />11:00am <br />11:00am <br />Final Reading (%); <br />13.000 in. <br />13.000 in. <br />13.250 in. <br />Test Duration (TF -T,): <br />1.00 hr. <br />1.00 hr. <br />1.00 hr. ' <br />Change in Reading (RF - R, y <br />0.0000 in. <br />0.0000 in. <br />0.0000 in. <br />PasslFail Threshold or Criteria: <br />ZERO LOSS <br />ZERO LOSS <br />ZERO LOSS <br />Test Result: <br />❑X Pass ❑ Fail <br />® Pass ❑ Fail <br />CjX` Pass ❑ Fail ❑ Pass ® Fail <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, accunde and /n full compliance with legal requirements. <br />Technician's <br />Date• X29/12 <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 />