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E <br />0 SWRCB, January 2006 <br />Spfll 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 <br />printouts from tests (if applicable), should be provided to the facility owner/op erator for submittal to the local regulatory agency. <br />r A Ar A Vlrd"IXT <br />Facility Name: SINCLAIR Date of Testing: 02-26-2015 <br />Facility Address: 1001 E. YOSEMITE, MANTECA, CA 95336 <br />Facility Contact: I Phone: (209) 825-4565 <br />Date Local Agency Was Notified of Testing: 02-18-2015 <br />RTame of Local Ap-enev Insnector (if present during testing): ELENAMANZO <br />2. TESTING CONTRACTOR INFORMATION <br />Co e: KAISER COMMERCIAL PETROLEUM <br />Technician Conducting Test: GREG KAISER <br />Credentialsi: 9 CSLB Contractor 0 ICC Service Tech. 0 SWRCB Tank Tester 0 Other (Specify) <br />License Number(s): CSLB No. 859535, ICC No. 5252318 <br />3. SPELL BUCKET TESTING INFORMATION <br />Test Method Used: E Hydrostatic 0 Vacuum 0 Other <br />-- β€”1--ITβ€”A. I&WAIMD ANM'rAPV MVAQIrRF. Eauinment Resolution: 1/16 <br />Identify Spill Bucket (By Tank <br />Number, stored Product, etc. <br />Bucket Installation Type: <br />1 2 <br />REG UNL PREMIUM <br />m Direct Bury s Direct Bury <br />[I Contained in Sump [I Contained in Sump <br />3 <br />DIESEL <br />11 Direct Bury <br />0 Contained in Sump <br />4 <br />0 Direct Bury <br />0 Contained in Sump <br />Bucket Diameter: <br />11 11 <br />11 <br />Bucket Depth: <br />13 13 <br />13.5 <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TO: <br />9:00 9:00 <br />9:00 <br />Initial Reading (R4): <br />12.0 12.0 <br />13. <br />Test End Time (TF): <br />10:00 10:00 <br />10:00 <br />Final Reading (RF): <br />12.0 12.0 <br />13. <br />Test Duration (TF β€” TO: <br />1 HR I HR <br />1 HR <br />Change in Reading (RF - <br />0 0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />PASS PASS <br />PASS <br />Test Result <br />0 Fail n Pass 0 Fail <br />cg Pass 0 Fail <br />0 Pass 0 Fail <br />Comments β€” <br />on repairs made prior to testing, and <br />CERTIFICATION OF <br />77?W177T! Sri <br />Technician's Signature:, <br />W n'2 - 2 211 <br />Date: 02-26-2015 <br />State laws and regulations do nb urrently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />