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SWRCB, January 2006 <br />SPILL BUCKET TESTING REPORT FORM <br />Thbr form is intended for use by contractors performing annual testing of UST spill containment structures. The completed farm and printout f -om <br />tests (if applicable), should be provided to rhe ac•ility nwner/operatorJor submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facili Name: Pacific Bell Telephone Co. dba AT&T California <br />Date of Testin :05/1312010 <br />Facility Address: 345 N. SAN JOA UIN STOCKTON CA 95202 <br />GEO PAR # UE042 <br />Facilit Contact: Connie Mitchell <br />Facili Phone: 209-598-5155 <br />Date Local Agency Was Notified of Testing: 04/27/2010 <br />Name of Local Agency Inspector if present during testing): Jeff Wong, <br />San Joaquin Count <br />2. TESTING CONTRACTOR INFORMATION <br />Company Natne: TAIT ENVIRONMENTAL SERVICES <br />Technician Conducting Test: Victor Guerrero <br />Credentials: ®CSLB Contractor ®ICC Service Tech ❑SWRCB Tank <br />❑ <br />Tester Other (Specify) <br />License Number(s): A ASB HAZB C -i0; 588099:8017001 -UT <br />Test Method Used <br />3. SPILL BUCKET TESTING INFORMATION <br />❑Vacuum ❑Other <br />Eauinment Resolution: 1116" <br />A4 myy Spill Bucker (By Tank Number. 1 UE042000t 2 3 4 <br />stored prodint. etc) <br />Bucket Installation Type <br />❑Direct Bury <br />®Contained in Sump <br />❑On too of AST <br />❑Direct Bury <br />[]Contained in Sump <br />❑On top of AST <br />❑Direct Bury <br />❑Contained in Sump <br />0 O to of AST <br />El Direct Bury <br />❑Contained in Sump <br />❑Onto of AST <br />Bucket Diameter inches <br />13 I/4" <br />Bucket Depth inches <br />14 1/2" <br />Wait Time between applying <br />vacuum/water and start of test <br />15 MIN <br />Test Start Time: <br />10:45 AM <br />Initial Reading Ri): <br />14" <br />Test End Time: <br />11:45 AM <br />Final Reading (Rf): <br />14" <br />Test Duration: <br />1 HOUR <br />Chan a in Readin Rf - Ri : <br />110 <br />Pass/Fail Threshold or Criteria: <br />Eopass <br />'fest Result <br />Comments: All test water used was taken back to Tait's shop. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained inthisreport is true, accurate and in full compliance with legal requirements <br />Technician's Signature_ _ / ter- l_ Date 05/13/2010 <br />