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S Bucket Testing Report Forro <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts <br /> Fran tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION CLLC: SKTNCA01 GEO PAR: UE-042 <br /> Facility Name: AT&T/SBC I Date of Testing: 7/19/06 <br /> Facility Address: 345 N. SAN JOAQUIN,STOCKTON <br /> Facility Contact: TOM WILLIAMS Phone: 209-466-1010 <br /> Date Local Agency Was Notified of Testing: 48 HOURS PRIOR(MIN) <br /> Name of Local Agency Inspector(if present during testing): SAN JOAQUIN ENVIRONMENTAL HEALTH <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SYSTEMS <br /> Technician Conducting Test: MICHAEL L.STRAWN,II <br /> Credentials: ®CSLB Contractor ®ICC Service Tech. SWRCB Tank Tester Other(Specify) <br /> License Number(s): A B ASB C-10 HAZ License Number: 588098 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic Vacuum Other <br /> Test Equipment Used: VISUAL/MEASURE Equipment Resolution: <br /> Identify Spill Bucket (By Tank 1 TANK #1052 2 3 4 <br /> Number, Stored Product, DIESEL FILL <br /> etc.) BUCKET <br /> Bucket Installation Type: Direct Bury Direct Bury Direct Bury Direct Bury <br /> ®Contained in Sump Contained in Sump Contained in Sump Contained in Sum <br /> Bucket Diameter: ill, <br /> Bucket Depth: 10" <br /> Wait time between applying 15 MINUTES <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 10:00 A.M. <br /> Initial Reading(Ri): 9.25" <br /> Test End Time(TF): 11:00 A.M. <br /> Final Reading(RF): 9.25" <br /> Test Duration(TF—Tj): 1 HOUR <br /> Change in Reading(RF-Rl): 0" <br /> Pass/Fail Threshold or 002„ <br /> Criteria: <br /> Test Result: ® Pass Fail Pass FailPass Fail Pass Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> *All hazardous test water was re-contained in (1)S gallon steel drum. Drum is labeled non-haz and is <br /> Ready for ick-up. <br /> *Spill Bucket passed test. No repairs are needed at present time. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information contained in this report is true,accurate,and in full compliance with legal requirements. <br /> Technician's Signa r Date:_7/19/06 <br />