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lespill Bucket Testing Report Forno <br /> This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br /> printouts from tests(if applicable),should be provided to the facility owner/operatorforsubmittal to the local regulatory agency. <br /> FACILITY INFORMATION Facility ID: UE046 <br /> Facility Name: Pacific Bell Telephone Co. dba AT&T California Date of Testing:3/3/2015 <br /> Facility Address: 907 LINCOLN RD., Stockton,CA 95207 <br /> Facility Contact: Thuy Tran Phone: 209-4744022 �. . <br /> Date Local Agency Was Notified of Testing. 2015-02-12 <br /> Name of Local Agency Inspector(ifpresent during testing): Fatinah Zareef <br /> TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT Environmental Services,Inc. EN IRONMEMN . <br /> g ., a-- <br /> Technician Conducting Test: Dan Luck <br /> Credential 1 : r CSLB Contractor ICC Service Tech. F SWRCB Tank Tester F Other(Specify) <br /> License number(s): A B ASB C-10 HAZ License Number 588098 : 5252167-UT <br /> SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: Hydrostatic r Vacuum F Other <br /> Test Equipment Used: Tape Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 UE046U002 <br /> Number,Stored Product,etc. <br /> Bucket Installation Type: r Direct Bury F Direct Bury F Direct Bury F Direct Bury <br /> Contained in Sump Contained in Sump F Contained in Sump r—Contained in Sump <br /> On top of AST On top of AST On top of AST F On top of AST <br /> Bucket Diameter: 11" <br /> Bucket Depth: 14 3/4" <br /> Wait time between applying 15 min <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 9:02am <br /> Initial Reading(Rt): 14 1/2" <br /> Test End Time(TF): 10:02am <br /> Final Reading(RF): 14 1/2" <br /> Test Duration(TF—Ti): I hour <br /> Change in Reading(RF-RI): 0 <br /> Pass/Fail Threshold or 0 <br /> Criteria: <br /> Test Result: W Pass FFail F Pass F Fail F Pass F Fail Pass r Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test water returned to TAIT shop. <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: Date: 3/3/2015 <br />