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Jul 08 09 11:34a Elite Iv Contractors Inc 2094616342 P.5 <br />0 <br />SVIRCB, Jun=y 2006 <br />Spill Bucket TestingReport Form <br />my form IS Iintendedfor use by contractors testing of USTspill containment structures. 773e complete <br />dform a <br />nd <br />Pr,,t0ujjfr6ntests (if applicable), xhouddbe pr6Wdcd10AefOcilitY owner/operator for submittal to the local regl#OYa9d*. <br />1. IFAC MORMTION <br />.JLM <br />-Mel A- of Tes <br />Facility Name: <br />Date I <br />Facility Address, iJ <br />Facility Coo Phone: <br />bate Local AgctacyW2.S otified of Tcsdmp,.- <br />of Local Agency Inspector AfPre4cHt during testing;}: <br />Conv= Name: <br />Technic'= Conducting Test: <br />a;—CICU611s'7 0 C,91.33 Contractor <br />Licemw NUrT1bc1(5)-- 5{6 I <br />FVM <br />i, i-rch- 0 SWRCB Tank Testcr 0 Other <br />0 <br />Comments — Cinclude fnformatlog on repairS made r)or to m1mg, anti. <br />CERTIFICATION Or, TECM41CLAN RESPONSIBLE FOR CON'>VCTTK G TWS TESTINGleyalrequiremeum. <br />port is true, accffrate� and bs full COMPIldnce with <br />1hereby certify Mat Illi the inVormation.contained in this. re <br />Teebnician's.sipatac. ate: <br />xed =Vi <br />State laws and regulations c4o tact currently require testing to be perforwed by a Tulif contractor. However, lWa1'rm=t1; <br />may be inore -strinv=t. <br />