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. A <br />SWRCB, January 2006 <br />Spill Bucket Testing Report Form <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 (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />I IPA f'TT 7T1V Y%T flit Air A rvi6.,.T <br />Facility Name: HAMMER LANE OIL Date of Testing: 06-22-09 <br />Facility Address: 3304 W. Hammer Lane Stockton CA 95206 <br />Facility Contact: Mike Gurm I Phone: 209-478-9293 <br />Date Local Agency Was Notified of Testing: 06-11-09 <br />Name of Local Agency Inspector (afpresent during testing): <br />1. TES'FIiNG CONTRACTOR O TION <br />Company Name: Reliable Petroleum Services Inc. <br />Technician Conducting Test: Robert Barnhart <br />Credentials': X CSLB Contractor X ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) <br />License Number(s): 883706 5252540 -UT <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: X Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: Standard Tape Measure Equipment Resolution: <br />Identify Spill Bucket(By Tank <br />Number, Stored Product, etc. <br />Tl: 87 Fill <br />T2: 91 Fill T3: Diesel <br />Bucket Installation Type: <br />X Direct Bury <br />Contained in Sum <br />X Direct Bury X Direct Bury <br />Contained in Sum Contained in <br />Bucket Diameter: <br />12" <br />12" 1299 <br />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test: <br />121/F__ <br />lmin. <br />12" 12'/" <br />Imin. lmin. <br />Test Start Time (TO: <br />9:102.111 <br />9:10a.m 9:10a.m <br />Initial Reading (Rj): <br />11" <br />11 '/' 117/8" <br />Test End Time (TF): <br />10:17a.m <br />10:17a.m 10:17a.m <br />Final Reading (RF): <br />11' <br />11 '/" 117/8" <br />Test Duration (TF — TO: <br />1hr. 7min. <br />lhr. 7min. lhr. 7min. <br />Change in Reading (RF - R j: <br />Pass/Fail Threshold or <br />0 <br />0 0 <br />Direct Bury <br />Contained in <br />Criteria: 1/16" 1/16" - 1/16" <br />TestResult: X Pass Fail X Pass Fail X Pass Fail Pass Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow -u 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 />/'1 ! <br />Technician's Signature: <br />Date: 06-22-09 <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 />