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RECEIVED <br />SWRCB, January 2006 <br />Spill Bucket Testing Report Form FEB 0 5 2014 <br />This form is intendedfor use by contractors performing annual testing of UST spill containment structu A� <br />printouts from tests (if applicable), should be provided to the facility ownerloperatorfor submittal to th'&W <br />M <br />HEAND A <br />I 1RA(CYT .TTVTVFnRM1ATFnN <br />Facility Name: TRACY VALERO Date of Testing: 9/5/13 <br />Facility Address: 2375 N. TRACY BLVD. TRACY, CA 95377 <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing :9/3/13 <br />Name of Local Agency Inspector (if present during testing): TWT <br />Company Name: AFFORDA TEST 416 2nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 <br />Technician Conducting Test: El Lyle D. Nimmo Z Zane A. NimmoE] David A. Winkler [] Felix G. Ramirez <br />5249115 -UT 5263322 -UT 5263373-TJT 5273934 -UT <br />Credentials': Z ICC Service Tech. Z SWRCB Tank Tester <br />2 CWT ir 'RTT4-WrT T'FQTTT%T1'- INNnUMATTON <br />Test Method Used: <br />Z Hydrostatic <br />E] vacuum <br />El- Other <br />Test Equipment Used: TAPE MEASURE, <br />H2O <br />Equipment Resolution: <br />1/16" <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, eLC-2- <br />1 87 <br />2 89 <br />3 91 <br />4 <br />Bucket Installation Type: <br />Z Direct Bury <br />El Contained in <br />Z Direct Bury <br />Sump 71 Contained in Sump <br />Bury <br />[] Contained in <br />Sump <br />❑ Direct Bury <br />F� Contained in <br />Sump <br />Bucket Diameter: <br />11 <br />11 <br />--ll <br />Bucket Depth: <br />12 3/4 <br />12 <br />12 3/4 <br />Wait time between applying <br />vacuum/water and start of test: <br />F <br />Test Start Time (Ti): <br />10900 <br />1 0900 <br />0900 <br />Initial Reading (RI): <br />11 3/4 <br />10 3/4 <br />11 -- <br />Test End Time (TF): <br />1000 <br />1000 <br />1000 <br />Final Reading (RF): <br />11 3/4 <br />10 3/4 <br />ll -- <br />Test Duration (TF — TF): <br />HR <br />HR <br />HR <br />Change in Reading (RF - RI): <br />0 <br />0 <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />R <br />sa" <br />-A <br />4 s R <br />4'" <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <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 Date: <br />State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />