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SWRCB,January 2006 <br /> SPILL BUCKET TESTING REPORT FORM <br /> This form is handedfir use by <br /> contractors multaww of USrspol cotanmet s&ucmrThe complete!form and pHntoutlrom <br /> tests(nfapplicable),should bepovddto e aclyeforsubm10al <br /> to the local negularory qgency. <br /> 1.FACILITY INFORMATION <br /> Facili Name:Pacific Bell Telephone Co.dba AT&T California Date of Testing:05/10/2011 <br /> Facility Address: 10 E. 12TH ST.,TRACY CA 95376 GEO PAR#UE058 <br /> Facility Contact:Connie Mitchell F,,ilft,Phone:209-474-4022 <br /> Date Local Agency Was Notified of T :03/31/2011 <br /> Name of Local A if t dWW testing):Thuy Tran <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TATr ENVIRONMENTAL SERVICES <br /> Technician Co Test-.victor Guerrero <br /> Credentials: ®CSLB Contractor ®ICC Service Tech ❑T Tank ❑Other(Specify) <br /> License Number(s):A ASB HAZB C-10. 588098.8017001-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:Tam Measure 113,quipment Resolution:1/16- <br /> 1= <br /> /16" <br /> 1=S- eac4er(By Tarr Number, 1 UEOSSUO02 2 3 4 <br /> St Product,uc) <br /> ❑Direct Bury ❑Direct Bury ❑Drtact Bury ❑Direct Bury <br /> Bucket Installation Type NContantedinsump ❑Contained m srmop ❑Contained in Sump ❑Contained in Sump <br /> ❑On of AST ❑on Lop of AST Don tw of AST ❑Onof AST <br /> Bucket Diameter(inches) l V <br /> Bucket Depth inches 141/2" <br /> Wait Time between applying 15 min <br /> vacuum/water and start of best <br /> Test Start Time: 12:35 Vm <br /> Initial Readin 13 3/4" <br /> Test End Time: 1:35 om <br /> Final Readm 13 3/4" <br /> Test Duration: 1 Hour <br /> Change in Reading -Ri : 0 <br /> Pass/Fail Threshold or Criteria: 0 <br /> Test Result Pala <br /> Comments:All test water was taken hack to Tait's shop. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the information centalaW in this report is true,accurate and In faH conqftm with <br /> lege!ratutremeats <br /> Technician's Signature 'j A.� Date 05/102011 <br />