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v <br /> S W RCB,January 2006 <br /> Spill Bucket Testing Report Form AUG 1 5 lilt" <br /> This firm is intendedfor use by contractors performing annual testing of UST spill containment structures. The e5nobts -ni and <br /> printouts from tests(if applicable),should be provided to thefacilitt.ownerloperatorfor submittal to the local rem clhftiry agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name:Manteca CO Date of Testing:2016-08-03 <br /> Facility Address:430 W. Center Street <br /> Facility Contact:Vincent Scheaffer Phone:(209)401-4547 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(ifpresent during testing):Timothy Engle <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:SunWest Engineering Const., Inc. <br /> Technician Conducting Test:David Smith <br /> Credentials: ❑CSLB Contractor ®ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec4f) <br /> License Number(s):8260473 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ❑✓ H drostatie ❑Vacuum ❑Other <br /> Test Equipment Used:Tape measure/visual Equipment Resolution: <br /> Identify Spill Bucket(4v Tank 1 rank 1 2 3 4 <br /> Number,Stored Product, etc) <br /> Bucker installation.Type: ❑Direct Bury [:]Direct Bury ❑Direct Bury ❑Direct Bury <br /> [:][DContained in Sump []Contained in Sume ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 112" <br /> Bucket Depth: 11" <br /> Wait time between applying <br /> 15 min' <br /> vacuu.ni/water and start of test*. <br /> Test Start Time(Ti): 0900am <br /> Initial Reading(Rj): 3/4"from top of bucket <br /> Test End Time(Tr): 1000a <br /> Final Reading(Rr): 314"from top of bucket <br /> Test Duration(Tr—Ti): 1 hr <br /> Change in Reading(RI:-RO: NaN <br /> Pass/Fail Threshold or 0 <br /> Criteria: <br /> Test Result: QPass [I Fail []Pass ❑Fait ❑Pass ❑Fail []Pass ❑Fail <br /> Comments— (include:information on re airs made rior to testing, and recommended ollow-u for firiled 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 /> jDavid Smith Dkt-O.m <br /> Dk.toss vitl 8 y C o.9sxi M Er�gircee�niq,w=3'.YC. <br /> aa*swaa U wrevea9eyfkiearing.wm.-US <br /> Technician's Signature: W.1 201909U3t0:43.51 DrW Date:2016-08-03 <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 />