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AFFORDA-TE$T 416 2nc! Street Galt CA 95632 <br />(209) 744-0112 (209) 744-0116 FA) <br />SITE NAME <br />ADDRESS <br />43 5 Z (7- <br />4 OL (4 <br />Z-AOLet t kj <br />3. SPILL BU KETTEST]INGUNTPQRXIATION <br />Spill Bucket <br />Test Report <br />TEST DATE p <br />PHONE (7- P't <br />CONTACT: 2/S ���= <br />Present )/ Not Present <br />Test Method Used: <br />KHydrostatic <br />❑ Vacuum ❑ Other <br />Test Equipment Used: (� P (c z CD <br />( <br />Equipment Resolution:MEN <br />i <br />Identify Spill Bucket (ay Tank <br />1 <br />2 "! Eq <br />�/� <br />4 <br />Number, Stored Product etc. <br />l <br />Bucket Installation Type: <br />❑ Direct B �' <br />❑ Direct Bury <br />DirBury <br />❑ Direct Bury <br />Contained in SuInP <br />A Contained in Sump <br />AContained in Sump <br />❑ Contained in S ump <br />Bucket Diameter: <br />/,I-- <br />/.X-- <br />17—— <br />ZBucket <br />BucketDepth: <br />Wait time between applying <br />vacuum/water and start of test: <br />.------ <br />Test Start Time (TO:®�,-- <br />Initial Reading (RO: <br />Test End Time (TF): <br />Final Reading (RF): <br />f <br />Test Duration (TF <br />Change in Reading (RF - R!): <br />Pass/Fail Threshold or <br />Criteria: <br />_ <br />' <br />• Comments. - (include information o -n repairs made prior to testing, and recommended ollow-up for failed tests) <br />�. Test Water: E] Taken with tester ®Left on site <br />I hereby certify that all the information contained in this report is true, <br />accurate, and in full compliance with legal requirements. Technician: , Zane A. Nimmo <br />ICC #: 5263322 -UT <br />Signature: - - - OTTL #: 04-187A <br />