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SWRCB,January 2006 <br /> SPILL BUCKET TESTING REPORT FORM <br /> This form is intended,for use by contractors pet forming unnual testing of UST spill containment structures. The completed Jortn and printout f-om <br /> tests(Y'applicable),should he provided to the facimy ox•ner,'operatorfar serbnutlal to the local regulatory agencv. <br /> 1.FACILITY INFORMATION <br /> Facility Name: Pacific Bell Telephone Co.dba AT&T California Date of Testing:05/25/2010 <br /> Facility Address: 10 E. 12TH ST.,TRACY CA 95376 GEO PAR#UE058 <br /> Facili Contact:Connie Mitchell Facilit Phone: <br /> Date Local Agency Was Notified of Testing:05/11/2010 <br /> Name of Local Agency Inspector(if present durin testin : Star Rivera <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test:Christopher Derosier <br /> Credentials: ®CSLB Contractor ®ICC Service Tech [SWRCB Tank eci Other(Specify) <br /> p fi <br /> License Numbers :A ASB HAZB C-10. 588098. 8009622-UT ICC#8009622-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum QOther <br /> Test Equipment Used: Tae Measure I Equipment Resolution: 1/16" <br /> ldentlfv Spill Bucket(Bv Tank Number, I UE058UO02 2 3 4 <br /> Stored product,etc) <br /> ❑Direct Bury ❑Direct Bury ❑Direct Bury I�Direct Bury <br /> Bucket Installation Type ®C'ontained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> ❑On top of AST ..... On top of AST On top of AST ❑On top of AST <br /> Bucket Diameter inches 13" <br /> Bucket Depth inches 14 1/2" <br /> Wait Time between applying 15 MIN <br /> vacuum/water and start of test <br /> Test Start Time: 11:45 AM <br /> Initial Reading Ri): 14 1/8" <br /> Test End Time: 12:45 PM <br /> Final.Reading(RQ., 14 1/8" <br /> Test Duration: 1 HOUR <br /> Chan e in Reading Rf-Ri : 0 <br /> Pass/Fail Threshold or Criteria: 0 <br /> tTest Result Pass <br /> Comments: Pumped out test water. Labeled water Non Haz and returned water to 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 c Date 05/25/2410 <br />