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SWRCB,January 2006 <br /> SPILL BUCKET TESTING REPORT FORM <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printout from <br /> tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name:Pacific Bell Telephone Co.dba AT&T California Date of Testing:06/18/2008 <br /> Facility Address: 10 E. 12TH ST. TRACY CA 95376 GEO PAR#UE058 <br /> Facility Contact:Mitchell Connie Facility Phone: <br /> Date Local Agency Was Notified of Testing:01/04/2008 <br /> Name of Local L*kEency Inspector if present during testing):Michelle Henry <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test:John Cascio <br /> Credentials: ❑SWRCB Tank ❑Other(Specify) <br /> ®CSLB Contractor ®ICC Service Tech Tester <br /> License Number(s):A ASB HAZB C-10. 588098: ICC 5252163-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br /> Test E ui ment Used:Visual/Measure lEguipment Resolution: 1/16" <br /> Idents Spill Bucket(By Tank Number, 1 UE058UO02 2 3 4 <br /> Stored Product,etc) <br /> Bucket Installation Type ❑Direct Bury ❑Direct Bury ❑Direct Bury F1 Direct Bury <br /> ®Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter inches 10" <br /> Bucket Depth inches 14.5" <br /> Wait Time between applying 15 min. <br /> vacuum/water and start of test <br /> Test Start Time: 1:00 Pm <br /> Initial Reading 14" <br /> Test End Time: 2:00 pm <br /> Final Reading MY 14" <br /> Test Duration: 1 hour <br /> Change in Reading Rf-Ri : 0 <br /> Pass/Fail Threshold or Criteria: 0 <br /> Test Result Pass <br /> Comments:Test water put in container labeled Non-Haz and returned to the contractors 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 SignaturDate 06/18/2008 <br />