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SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printouts from tests (if applicable) should be provided to the facility owner/operator for submittal to the local regulatory agency. Facility Name: CRLLC #5447 Date of Testing: 7/21/2014 Facility Address: 1469 E HAMMER LANE, STOCKTON, CA 95209 Facility Contact: ALLEN FAASS I Phone: (925) 884-0800 Date Local Agency Was Notified of Testing: 7/1&14 Name of Local Agency Inspector (rf present during testing): STACY Company Name: TANK TEK ENVIRONMENTAL CORPORATION Technician Conducting Test: RICHARD THOMAS Credentials: ® CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB Tank Tester ❑ Other (Spec) License Number(s): 803705 (CSLB Contractor) — 5254736 -UT (ICC Service Tech.) — 06-1672 (SWRCB Tank Tester) ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. 3. SPILL BUCKET TESTING INFORMATION Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other (Specify) Test Equipment Used: VISUAL - TAPE MEASURE Identify Spill Bucket (By Tank Number, Stored Product, etc.) 91 FILL Bucket Installation Type: ® Direct Bury ❑ Contained in Sump 88 FILL ® Direct Bury ❑ Contained in Equipment Resolution: 87 FILL ® Direct Bury Sump ❑ Contained in Sump 1/16" DIESEL FILL ® Direct Bury ❑ Contained in Sump Bucket Diameter: 12" 12" 12" 12'1 Bucket Depth: 15" 14" 13.75" 14.75" Wait time between applying vacuum/water and start of test: 10 MIN 10 MIN 10 MIN 10 MIN Test Start Time (TO: 8:30 AM 8:30 AM 8:30 AM 12:25 PM Initial Reading (RD: 13.50" 12.50" 12.25" 13.25" Test End Time (TF): 9:30 AM 8:30 AM 9:30 AM 12:40 PM Final Reading (RF): 13.50" 12.50" 12.25" 13.25" Test Duration (TF— Tj): 15 MIN 15 MIN 15 MIN 15 MIN Change in Reading (RF- Ra: 0 0 0 0 Pass/Fail Threshold or Criteria: NO LOSS NO LOSS NO LOSS NO LOSS COMMent3 — (include information on repairs made prior to testing, and recommended follow-up for failed tests) REPLACED DRAIN VALVE AT DIESEL SPILL BUCKET CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: �--& v—� Date: 7/21/2014 ' State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.