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i*RECEIVED <br />SWRCB, January 2006 <br />Spill Bucket Testing Report Form JL 2 9 2014 <br />This form is intended for use by contractors performing annual testing of UST spill contai t *ftm=tedormand <br />printouts from tests (if applicable), should be provided to the facility ownerioperator for su m' l <br />1_ FACH.TTV TNFnRMATTnN DEPARTMENT <br />Facility Name: LODI PAC PRIDE Date of Testing: 6-30-14 <br />Facility Address: 351 N BECKMAN LODI CA <br />Facility Contact: TED Phone: <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (ifpresent during testing: ARIS <br />IW" t -.T -ft 0) ta Q1 all):T,: I0 <br />Company Name: AFFORDA TEST 4162 nd Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 <br />Technician Conducting Test: ❑ Lyle D. Nimmo ❑ Zane A. Nimmo ® David A. Winkler ❑ Felix G. Ramirez <br />5249115 -UT 5263322 -UT 5263373 -UT 5273934 -UT <br />I Credentials': ® ICC Service Tech. ® SWRCB Tank Tester I <br />Test Method Used: ® Hydrostatic ❑ Vacuum ❑ Other <br />Test Equipment Used: H2O & <br />TAPE MEASURE <br />Equipment Resolution: 1/16 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />1 RED DSL 2 DSL 2 <br />4 <br />Bucket Installation Type: <br />® Direct Bury Direct Bury <br />❑ Contained in Sump ❑ Contained in Sump <br />Direct Bury <br />❑ Contained in <br />Sum <br />Bucket Diameter: <br />11 11 <br />Bucket Depth: <br />13 13 <br />Wait time between applying <br />vacuum/water and start of test: <br />NA NA <br />NA <br />Test Start Time (TI): <br />9 9 <br />Initial Reading (RO: <br />12 12 <br />Test End Time (TF): <br />10 10 <br />Final Reading (RF): <br />12 12 <br />Test Duration (TF - TI): <br />1 HR 1 HR <br />Change in Reading (RF - RI): <br />0 0 <br />Pass/Fail Threshold or <br />Criteria: <br />1/16 1/16 <br />Test tilt: <br />Pass <br />❑ Fall 1 ® kiss ❑ Fail <br />Z Pass ❑ Fail <br />❑ Pass ❑ <br />Fail <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />QDW <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 />Technician's Signature: V -6-j <br />Date 6-30-14 <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 />