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SWRCB, January 2006 <br />' 9.I Bucket Testing Reporeorm <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 (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />Facility Name: KAISER MANTECA <br />Date of Testing: 08/30/2007 <br />Facility Address: 1777 W YOSEMITE AVE , MANTECA, CA, 95337 <br />Facility Contact: JAMES BRAKKEE <br />Phone: (2 0 9) 825-3460 <br />Date Local Agency Was Notified of Testing : 0 8 / 2 0 / 2 0 0 7 <br />Name of Local Agency Inspector (if present during testing): Muniappa Naidu <br />CONTRACTOR2. TESTING INFORMATION <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: DOUG FALDE <br />Credentials) : <br />❑ <br />CSLB Contractor <br />0 <br />ICC Service Tech. <br />1:1 SWRCB Tank Tester <br />E <br />Other (Specify) I CC <br />License Number: 5307847 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />E] Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: TEST FLUID AND TAPE MEASURE Equipment Resolution: <br />Identify Spill Bucket(By Tank <br />' 1 DIE FILL <br />2 3 4 <br />Number, Stored Product, etc) <br />® Direct Bury <br />❑ Direct Bury � Direct Bury F-1Direct Bury <br />Bucket Installation Type: <br />❑ Contained in Sump <br />❑ Contained in Sump ❑ Contained in Sump ❑ Contained in Sump <br />Bucket Diameter: <br />11.00 <br />Bucket Depth: <br />13.00 <br />Wait time between applying <br />5MIN <br />vacuum/water and starting test: <br />Test Start Time (TI ): <br />1200 <br />Initial Reading (RI ): <br />10.00 <br />Test End Time (TF ): <br />1300 <br />Final Reading (R F ): <br />10.00 <br />Test Duration: <br />1HR <br />Change in Reading (R F - RI ): <br />0.00 <br />Pass/Fail Threshold or <br />P <br />Criteria: <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />New certification. Unknown expiration. <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: <br />Date: 08/30/2007 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />