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MAY-13-2008 04:39P FROM: 70:4683433 P.25 <br /> fo <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Form <br /> Thisformis w1endedfor we by contractors performing annuat testing of UST spit!containment strochwea The completed forin and <br /> printouts frown tests(ij*plkable),shmdd be provided to thafacifity ownerloperatorforsubmittal to the local regulatory agency. <br /> 1. FA TTY VFORMATION <br /> Facility Narita: TRACY TRUCK AND AUTO STOP Date of Leg 3/26M <br /> Facility Address: 3940 N.Tracy Blvd Tracy Ca.95376 -: Phone: (209)$32-5006 <br /> Facility Contact: Debbie Jutla <br /> Date Local Agency Was Notified of Testing: 3/0"9 <br /> Name of Local Agency Inspector(Ifpresent dw*rg testing): Michelle Henry <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company RE LIT PETROLEUM SERVICES INC. <br /> Technician Conducting Test Guadalupe Sanchez <br /> Credentials'. X CSI-B Contractor X ICC Service Tech. 0 SWRCB,Tank Tester D Other(Specify) <br /> License Number(s): SM706 5250451-UT <br /> 3. SPILL BUCTUTTE&M, G INFORMATION <br /> Test Method Used: X Hydrostatic ovacumn 0 Other <br /> Test Equipment Used: Standard Tape Messure Equipment Rewlutiore <br /> Identify Spill Bucket(By Tank TI:87 Unleaded TI:91 Supreate T3: Diesel 2 West VC Diesel 2 East <br /> Number.Stared Noducs, Etc Fill Fill InK Fin <br /> Bucket Installation Type: X Direct Bury X Direct Bury x Direct Bury X Direct Bury <br /> Contained in Sum R Contained in Su Contained in Su Ee Contained in SuTR. <br /> Bucket is broken and <br /> Bucket Diameter Needs to be replaced. 1291 12" 12" <br /> Bucket TV*: Not Itested 13 VP 12 /,?' 13 lA" <br /> Wait time between applying I min. I min. I MIRL <br /> vacuum/water and start of test <br /> Tog Start Time(Tj: 9:32am 9:3.1am 9:3NLm <br /> Initial Reading(Pq): 9 1/16" 11" 7 111le <br /> Test End Time(Tv): 10-552.m 10:55&m 9:429.m. <br /> Final Readft(R# 9 VIP 11" 7 1/16" <br /> Test Duration(TF—Te): I hr.23mhL 1hr.240310. 12 min. <br /> Change in Reading(RF-12r): 0 0 5/8" <br /> PaWFail Threshold or 1/16" 1/16" <br /> Criteria: <br /> Test Result.- Pass X Fail X PASS Fail X Pm Fail Pass X Fail <br /> Comments—L=ude Information on Ee airs made prior to tesit&and�e a <br /> L_ p _���Jorf failed tests) <br /> Rgmaired T4: Dipsol 2 Eogt_fi(J. bgx(rcajaged fill Ladauter gasket & fill can reMl <br /> _ <br /> The 4" nitinle md mtested--T=nassed—will schedud itnesq tedv-j,+U <br /> in_ hector <br /> CERICMCA'nON OF TECHNICIAN RESPONS(BLE FOR CONDUCHNG THIS TESTING <br /> I hereby c4vdfy efter ail the lafarmaden contained in thbrepart is trite,accurate,and hifaM comptlance with kgot re"iremenn. <br /> Technician's Signaturee�— Date: AMA <br /> 40� <br /> `State laws and regulations do not currandy require testing to be perfibmied by a qualified contractor.However,local requirements <br /> may be more stringent <br />