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ill Bucket Testing Report Form 0 <br />This form is intendedfor 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 />FACILITY INFORMATION Facilitv ID: UE042 <br />Facility Name: Pacific Bell Telephone Co. dba AT&T California Date of Testing: 8/26/2014 <br />Facility Address: 345 N. SAN JOAQUIN, Stockton, CA 95202 <br />Facility Contact: Thuy Tran <br />Phone: (209) 532-3447 n C., %a `. r. <br />Date Local Agency Was Notified of Testing. 2014-07-29 <br />Name of Local Agency Inspector (if present during testing): Fatinah Zareef SEP <br />TFRTiNf_ VnNTRACTnR INMRMATTON <br />ENVIRONMENTAL HEAF <br />Company Name: TAIT Environmental Services, Inc. DEPARTMENT <br />Technician Conducting Test: Victor Guerrero <br />Credential 1 : F CSLB Contractor [ ICC Service Tech. r SWRCB Tank Tester r_ Other (Specify) <br />License number(s): A B ASB C-10 HAZ License Number 588098 : 8017001 -UT <br />CPii.i. RITCKF.TTRQTiNf_iNmRMATinN <br />Test Method Used: <br />F Hydrostatic <br />r Vacuum <br />Other <br />Test Equipment Used: Tape Measure <br />Equipment Resolution: 1/16" <br />Identify Spill Bucket (By Tank I UE042U001 <br />Number, Stored Product, etc.) <br />Bucket Installation Type: <br />r- Direct Bury <br />F Contained in Sump <br />r On top of AST <br />Direct Bury <br />Contained in Sump <br />On top of AST <br />r— Direct Bury <br />Contained in Sump <br />( On top of AST <br />Direct Bury <br />r— Contained in Sump <br />r On top of AST <br />Bucket Diameter: <br />11" <br />Bucket Depth: <br />14.25" <br />Wait time between applying <br />vacuum/water and start of test: <br />15 min. <br />Test Start Time (TI): <br />9:01 am <br />Initial Reading (R,): <br />13.5" <br />Test End Time (TF): <br />10:01 am <br />Final Reading (RF): <br />13.5" <br />Test Duration (TF —Tj): <br />1 hour <br />Change in Reading (RF -RI): <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />0 <br />Test Result: <br />F Pass r— Fail <br />F_ Pass r— Fail <br />r— Pass r --Fail <br />Pass r Fail <br />Comments —(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />All test water was taken backto Tait's shop. <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 Signature:% e Date: 8/26/2014 <br />