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Page_of _ <br /> 9. Spill Bucket 'Testing Report For <br /> This form is intended far 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 ownerloperatorfor submittal to the local regulatory agency. <br /> FACILITY INFORMATION <br /> Facility Name: PAC BELL dba AT&T CALIFORNIA Date of Testing: 07/05/07 <br /> Facility Address: 10 EAST 12T"STREET,TRACY,CA <br /> Facility Contact: CONNIE MITCHELL Phone: (209)474-4022 <br /> Date Local Agency Was Notified of Testing: 06/04/07 <br /> Name of Local Agency Inspector(ifpresent during testing: SAN JOAQUIN HEALTH DEPT. <br /> TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test: MICHAEL STRAWN <br /> Credentials': ®CSLB Contractor ®ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Specify) <br /> License Number(s): CSLB=588098 ICC=5262091 -UT <br /> SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum ❑ Other <br /> Test Equipment Used:VISUAL-MEASURE Equipment Resolution: <br /> Identify Spill Bucket(By Tank 1 TANK 1232 2 3 4 <br /> Number,Stored Product, etc.) DIESEL FILL BKT. <br /> Bucket Installation Type: ❑Direct Bury ❑Direct Bury Q Direct Bury ❑Direct Bury <br /> ®Contained in Sump ❑Contained in Sum ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 11 INCHES <br /> Bucket Depth: 10 INCHES <br /> Wait time between applying 15 MINUTES <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 11:20 <br /> Initial Reading(Ri): 9.75 INCHES <br /> Test End Time(TF): 12:20 <br /> Final Reading(RF): 9.75 INCHES <br /> Test Duration(TF—Tj): ONE HOUR <br /> Change in Reading(RF-Ri): 0 <br /> Pass/FaiI Threshold or 0 <br /> Criteria: <br /> Test Result: ® Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑Fait ❑ Pass ❑Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> ALL HYDROSTATIC TEST WATER WAS RECONTAINED IN(1)FIVE GALLON POLY DRUM. <br /> DRUM IS LABELED AS NON HAZ AND WAS REMOVED BY TAIT. <br /> CERTIFICATION O CIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> I hereby certify that all the inform tion contained in t is true,accurate, and in full compliance with legal requirements. <br /> Technician's Signature: Date: 07/05/07 <br /> State laws and regulations do not currently ire�teso be performed by a qualified contractor.However,local requirements <br /> maybe more stringent. <br />