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0 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report For <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: Stockton AASF I Date of Testing: 8/4/2010 <br /> Facility Address: 2000 Stimson RD Stockton CA.95206 <br /> Facility Contact: MSG Pica Phone: 209-983-5331 <br /> Date Local Agency Was Notified of Testing: 48 hr+ <br /> Name of Local Agency Inspector(fpresent during testing): Muniappa Naidu San Joaquin CO. <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Tank Team inc, <br /> Technician Conducting Test: Hector Galindo <br /> Credentials': x CSLB Contractor, x ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): 512835 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: x Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:tape measure Equipment Resolution%1/16" <br /> Identify Spill Bucket HTankkk 2 3 4 <br /> Number, StoredProdirect Bury Direct Bury ❑Direct Bury ❑Direct Bury <br /> Bucket Installation Tyntained in Sump ❑Contained in Sump ❑Contained in Sum ❑Contained in Sum <br /> Bucket Diameter: 12" <br /> Bucket Depth: 12" <br /> Wait time between applying 30 min <br /> vacuum/water and start of test: <br /> Test Start Time(TI): 10:15 <br /> Initial Reading(R): <br /> /49 3 " <br /> Test End Time(TF): 11:15 <br /> Final Reading(RF): <br /> 9 3/4» <br /> Test Duration(TF—TI): 1 hr <br /> Change in Reading(RF-RI): 0 <br /> Pass/Fail Threshold or .002" <br /> Criteria: <br /> Test Result: x Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail ❑ Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-u for failed tests) <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the info ' n c ntaitted art this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signature: Date:8/4/2010 <br /> '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 />