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Ll <br />*EGEIVEL <br />150710-349 <br />SEP B, January 200b <br />Spill Bucket Testing Report Form <br />Thisfirm is intended. for use by contractors performing annual testing of • UST spill contai 4a w � form and <br />j�l <br />printouts from tests (if applicable), should be provided to the facility ownerloperator for submittal to�'he Focair�e titory agency. <br />1. FACILITY INFORMATION <br />Facility Name: Manteca CC Date of Testing: 8-4-2015 <br />Facility Address: 430 W. Center Street <br />Facility Contact: Vincent scheaffer Phone: 209-401-4547 <br />Date Local Agency Was Notified of Testing: 48hrs prior <br />Name of Local Agency Inspector (i resent during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Sunwest Engineering <br />Technician Conducting Test: David Smith <br />Credentials : CSLB Contractor❑ ICG Service Tech. X❑ SWRCB Tank Tester!] Other (Specify) <br />License Number(s): 8260473 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used: lake <br />Test Equipment Used: tape measure 11 visual <br />Identify Spill Bucket (by Tanktank <br />Number Stored Product, etc. <br />1 <br />1— <br />E L <br />Bucket Installation Type:W-rect <br />Bury <br />ntained in Sump <br />irect Bury irect Bury <br />ntained in Sump Montained in Sum <br />irect Bury <br />ntained in Sum <br />Bucket Diameter: <br />12" <br />Bucket Depth. <br />11" <br />Wait time between applying <br />vacuum/water and start of test: <br />15 min. <br />Test Start Time (Ti): <br />1:30pm <br />Initial Reading (RI): <br />1" from bucket top <br />Test End Time (TF): <br />2:30pm <br />Final Reading (RF): <br />1" from bucket top <br />Test Duration (TF- TI): <br />1 hr <br />Change in Reading (R F- Ri): <br />0 <br />Pass/Fail Threshold or <br />Criteria: <br />0 <br />T <br />Test Results <br />Mass <br />:.. ....., <br />Comments - (include information on repairs made <br />prior to testing, and recommended follow-up far 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 />Digitally signed by Smith David V0150710 -N9 <br />Technician's Signature: 5041201517:02:12 Date: 8/4/2015 <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 />