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CEIVEDece� <br />E-C9It%CtiWL-ct <br />Spill Bucket Testing Report Form ME 2 0 2012 <br />This form is intended for use by contractors performing annual testing of UST spill con "' leted form and <br />printouts from tests (f applicable), should be provided to the facility owner/operator for s*J tory agency. <br />Facility Name: Bonfare #35 1 Date of Testing: 12/05/2012 <br />Facility Address: 15 E. Grantline Rd., Tracy, CA 95376 <br />Facility Contact: Sean Kapoor I Phone: (209) 833-9619 <br />Date Local Agency Was Notified of Testing: 11/26/2012 <br />Name of Local Agency Inspector (afpresent during testing): Thuy Tran <br />Company Name: ECO-CHEK Compliance <br />Technician Conducting Test: Nikola Zagorov <br />Credentials': ® CSLB Contractor ® ICC Service Tech. M SWRCB Tank Tester ❑ Other (Spec) <br />License Number(s): 958763 A <br />Test Method Used: <br />® Hydrostatic <br />❑ Vacuum <br />❑ Other <br />Test Equipment Used: Tape Measure <br />Equipment Resolution: 1/16 Inches <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc. <br />I Super <br />2 Regular Syphon <br />3 Regular <br />4 <br />Bucket Installation Type: <br />❑ Direct Bury <br />® Contained in Sump <br />❑ Direct Bury <br />® Contained in Sump <br />❑ Direct Bury <br />® Contained in Sum <br />❑ Direct Bury <br />❑ Contained in Sum <br />Bucket Diameter: <br />12 Inches <br />12 Inches <br />12 Inches <br />Bucket Depth: <br />12 Inches <br />12 Inches <br />12 Inches <br />Wait time between applying <br />vacuum/water and start of test: <br />10 Minutes <br />10 Minutes <br />10 Minutes <br />Test Start Time (Ti): <br />09:45 AM <br />09:45 AM <br />09:45 A <br />Initial Reading (R,): <br />11 Inches <br />11 Inches <br />10 5/8 Inches <br />Test End Time (TF): <br />10:45 AM <br />10:45 AM <br />10:45 AM <br />Final Reading (RF): <br />11 Inches <br />11 Inches <br />10 5/8 Inches <br />Test Duration (TF— T,): <br />60 Minutes <br />60 Minutes <br />60 Minutes <br />Change in Reading (RF- RI): <br />0 Inches <br />0 Inches <br />0 Inches <br />Pass/Fail Threshold or <br />Criteria: <br />1/16 Inches <br />1/16 Inches <br />1/16 Inches <br />Test Result. <br />® Pass ❑ Fail <br />Z Pass ❑ FaiI <br />I ® Pass ❑ Fail <br />❑ Pass ❑ Fail <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1 hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. <br />Technician's Signature: rov Date: 12/05/2012 <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 />