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SWRCB, January 2006 <br />SPILL BUCKET TESTING REPORT FORM <br />This form is infemkd for use by contreaors performing annual testing of UST spill containmen! structures. The completed form and printout from <br />tests (if applicable), should be provided to the facility owner/operatorfor submittal to the local regulatory agency_ <br />1. FACILITY INFORMATION <br />Facility Name: AT&T Corporation Date of Testing: 06/02/2010 <br />Facili Address: 3110 W. Turner Rd., Lodi CA 95242 GEO PAR # UE231 <br />Facility Contact: Connie Mitchell Facility Phone: <br />Date Local Agency Was Notified of Testing: 05/05/2010 <br />Name of Local Agency Inspector if present during testing): Aris Caca it <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TAI T F,NVIR.ONMENTAL SERVICES <br />Technician Conducting Test: Christopher Derosier <br />Credentials: ®CSLB Contractor ®ICC Service Tech❑SWRCB Tank ❑Other (Specify) <br />Tester <br />License Num s : A ASB HAZB C-10. 588g28,,8009622 -VT, Frankiln Fuel #633613762 <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br />Test Equipment Used: Incon ui ment Resolution: .0006 <br />Identify Spill Bucker (By Tank Number, <br />Stored Anduct, etc) <br />1 UE231 UOO1 <br />2 <br />3 <br />4 <br />Bucket Installation Type <br />®Direct Bury <br />❑Contained in Sump <br />❑On top of AST <br />❑Direct Bury <br />❑Contained in Sump <br />EjOn top of AST <br />❑Direct Bury <br />El Contained in Sump <br />❑On top of AST <br />El Direct Bury <br />❑Contained in Sump <br />❑ On of AST <br />Bucket Diameter inches <br />12" <br />Bucket Depth inches <br />12" <br />Wait Time between applying <br />vacuum/water and start of test <br />15 MIN <br />Test Start Time: <br />9:56 AM 10:12 AM <br />Initial Reading <br />6.816 6.816 <br />Test End Time: <br />10:11 AM 10:27 <br />Final Reading <br />6.816 6.816 <br />Test Duration: <br />15 MIN 15 MIN <br />Chane in Readin Rf - Ri : <br />0 0 <br />Pass/Fail Threshold or Criteria: <br />.002 <br />Test Result <br />Pass <br />Comments: Pumped out water, labeled Non Haz. Returned water to Tait's shop. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1 hereby certify that sli the information contained in this report is true, accurate sari in rug compliance with legal requirements <br />Technician's Signature Date 06/02/2010 <br />