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Bucket <br />1 d o r ' Spillr <br />416 2nd Street 209 744-0112 Test Report <br />Galt. Ca. 95632 FAX r ..-0116 <br />1. FACILITY INFORMATION <br />L If <br />Facility Name: ,4LlCo t Date of Testing: t �, <br />Facility Address:3L164t'-� JTo ,2•„_ <br />Facility Contact: , t Phone: p <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />3. <br />SPILL BUCKET TESTING INFORMATION <br />Test Method Used: <br />Hydrostatic <br />0 Vacuum <br />❑ Other <br />Test Equipment Used: <br />Equipment Resolution: <br />Identify Spill Bucket (By Tank 1 <br />2 <br />3 4 <br />Number, Stored Product, etc. <br />l <br />Bucket Installation Type: 0 Direct Bury <br />❑ Direct Bury <br />❑ Direct Bury ❑ Direct Bury <br />Contained in S <br />Contained in Sump <br />gContained in S 0 Contained in Sump <br />Bucket Diameter: <br />1 <br />t Z <br />12— <br />2Bucket <br />Bucket Depth: <br />(3Iq <br />Wait time between applying <br />vacuum/water and start of test: <br />Test Start Time (TO: <br />2-1 <br />95 f <br />Initial Reading (RI): <br />( Z 316, <br />Test End Time (TF): <br />P b <br />o a r <br />t <br />Final Reading (RF): <br />Test Duration (TF — Tj): <br />Change in Reading (RF - RI): <br />Pass/Fail Threshold or <br />Criteria: <br />iii IgIN111I <br />Comments - (include information Av.repairs made <br />MID <br />prior to t sting, and recommended)bl1ow-up for failed tests). <br />ok JA <br />(i1 <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that a;tWmatin contained in. this report is true, accurate, and in full compliance with legal r quirementsTechnician's Signature��,� •.`�.,�... ,,�..,......_. Date: <br />