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v <br />17759 Buttercup Circle, Sonora, CA 95370 <br />Phone: 209-532-7320; Fax: 209-533-2650 <br />California Tank Tester: 90-1068 <br />California Contractor 623541 A-Haz <br />alltechmaiLci,me.com <br />J <br />Spill Bucket Testing Report Form <br />1. FACILITY INFORMATION <br />Facility Name: Mossdale Arco Date of Testing: May 13, 2009 <br />Facility Address: 444 Mossdale Road, Lathrop CA <br />Facility Contact: Nick Bokides Phone: (209) 234-1256 <br />Date Local Agency Was Notified of Testing <br />Name of Local Agency Inspector (if present during testing): Muniappa Naidu <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Alltech Petro Inc, 17759 Buttercup Circle, Sonora CA 95370. (209) 532-7320 <br />Technician Conducting Test: Isaac Anderson <br />Credentials': D CSLB Contractor 2 ICC Service Tech. SWRCB Tank Tester 0 Other (Spec) <br />License Number(s): ICC Certification: 8005930 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />® Hydrostatic <br />❑ Vacuum <br />Ej Other <br />Test Equipment Used: One Hour Observed Test <br />Identify Spill Bucket 1 87 <br />Bucket Installation Type: Direct Bury <br />ElIn Sump <br />2 91 <br />Direct Bury <br />ElIn Sump <br />Equipment Resolution: <br />3 DSL <br />Direct Bury <br />ElIn Sump <br />1/16" <br />4 <br />Direct Bury <br />ElIn Sum <br />Wait time between applying <br />vacuum/water and start of test: <br />0 <br />0 <br />0 <br />Test Start Time (Ti): <br />11:15 <br />12:00 <br />11:15 <br />Initial Reading (RI): <br />1 1/2" from grade <br />1 1/2" from grade <br />1 1/2" from grade <br />Test End Time (TF): <br />12:15 <br />13:00 <br />12:15 <br />Final Reading (RF): <br />1 1/2" from grade <br />1 1/2" from grade <br />1 1/2" from grade <br />Test Duration (TF — Tj): <br />1.0 Hr. <br />1.0 Hr. <br />1.0 Hr. <br />Change in Reading (RF - Rj): <br />0.0 <br />0.0 <br />0.0 <br />Pass/Fail Threshold or <br />Criteria: <br />0 <br />0 <br />0 <br />Test Result: <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments: <br />Technician: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />Date: 5/13/09 <br />