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SWRCB,January 2006 <br /> SPILL BUCKET TESTING REPORT FORM <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and printout from <br /> tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1.FACILITY INFORMATION <br /> Facility Name:Pacific Bell Telephone Co.dba AT&T California Date of Testing:06/17/2008 <br /> Facility Address:907 LINCOLN RD. STOCKTON CA 95207 GEO PAR#UE046 <br /> Facility Contact:CONNIE MITCHELL E.S.M. Facility Phone: <br /> Date Local Agency Was Notified of Testing:01/04/2008 <br /> Name of Local Agency Inspector if present during testing):SAN JOA UIN COUNTY HEALTH DEPARTMENT <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TAIT ENVIRONMENTAL SERVICES <br /> Technician Conducting Test:MICHAEL L.STRAWN II <br /> Credentials: ®CSLB Contractor MICC Service Tech ❑SWRCB Tank ❑Other(Specify) <br /> Tester <br /> License Number(s):A ASB HAZB C-10. 588098:ICC 5262091-UT <br /> 3.SPILL BUCKET TESTING INFORMATION <br /> Test Method Used ®Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used:VISUAL-MEASURE I Equipment Resolution:0.25 INCH <br /> Idents Spill Bucket(By Tank Number, 1#UE046U002 2 3 4 <br /> Stored Product,etc) <br /> Bucket Installation Type ❑Direct Bury ❑Direct Bury ❑Direct Bury ❑Direct Bury <br /> ®Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> Bucket Diameter inches 11 INCHES <br /> Bucket Depth inches 10 INCHES <br /> Wait Time between applying 15 MINUTES <br /> vacuum/water and start of test <br /> Test Start Time: 9:00 AM <br /> Initial Reading Ri): 9.75 INCHES <br /> Test End Time: 10:00 AM <br /> Final Reading(Rf): 9.75 INCHES <br /> Test Duration: 1 HOUR <br /> Chane in Re ding Rf-Ri : 0 INCHES <br /> Pass/Fail Threshold or Criteria: 0 INCHES <br /> Test Result Pass <br /> Comments:ALL HYDROSTATIC TEST WATER WAS RECONTAINED IN(1)5 GALLON POLY DRUM.DRUMS WAS <br /> LABELED AS NON-HAZ AND WAS REMOVED FROM SITE BY THE TESTING CONTRACTOR. <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 -:--- --------------I <br /> Date 06/17/2008 <br />