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RECEIVE <br /> L__1 <br /> 201SWRCB,January 2006 <br /> Spill Bucket Testing Report Form bb <br /> This form is intended for use by contractors performing annual testing of UST spill con c eted form and <br /> printouts from tests (if applicable),should be provided to the facility owner/operator for s tt tb�FllM3Th F*7datory agency. <br /> 1. FACILITY INFORMATION Facilit ID: UE046 <br /> Facility Name: Pacific Bell Telephone Co dba ATT California I Date of Testing: 02-18-2016 <br /> Facility Address: 907 Lincoln Rd. Stockton CA 95207 <br /> Facility Contact: Thuy Tran Phone:209-474-4022 <br /> Date Local Agency Was Notified of Testing: 1/14/2016 <br /> Name of Local Agency Inspector(if present during testing): Fatinah Zareef <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT Environmental Services <br /> Technician Conducting Test: John Cascio <br /> Credentials': OCSLB Contractor OICC Service Tech. ❑SWRCB Tank Tester [I Other(Specify) <br /> License Number(s): A B ASB C-10 HAZ,588098 5252163-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: ®Hydrostatic ❑Vacuum []Other <br /> Test Equipment Used: Visual Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 UE0460002 2 3 4 <br /> Number, Stored Product, etc.2. <br /> []Direct Bury []Direct Bury ❑Direct Bury []Direct Bury <br /> Bucket Installation Type: ®Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> ❑On Top of AST E10n Top of AST []On Top of AST ❑On Top of AST <br /> Bucket Diameter: 11.001° <br /> Bucket Depth: 15.50" <br /> Wait time between applying 15 Min <br /> vacuum/water and start of test: <br /> Test Start Time(Tj): 9:01 AM <br /> Initial Reading(Ri): 15.00" <br /> Test End Time(TF): 10:01AM <br /> Final Reading(RF): 15.00" <br /> Test Duration(TF—Tj): 1 Hour <br /> Change in Reading(RF-Rj): 0 <br /> Pass/Fail Threshold or <br /> Criteria: <br /> 0 <br /> Test Result: [R] Pass ❑Fail ❑ Pass ❑Fail ❑ Pass []Fail ElPass El Fail <br /> Comments—(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> Test Water Returned to Tait <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: iWa &Wza Date: 02-18-2016 <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 />