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LGLIVED <br /> 2016 <br /> SWRCB,January 2006 <br /> Spill Bucket Testing Report Fo <br /> -Ag-r n;:0A T FK1T <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/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION Facilit ID: UG010 <br /> Facility Name: Pacific Bell Telephone Co dba ATT California I Date of Testing: 02-18-2016 <br /> Facility Address: 1812 Coley Ave. Escalon CA 95320 <br /> Facility Contact: Thuy Tran Phone:209-474-4022 <br /> Date Local Agency Was Notified of Testing: 1/15/2016 <br /> Name of Local Agency Inspector(ifpresent during testing): Elena Manzo <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT Environmental Services <br /> Technician Conducting Test: John Cascio <br /> Credentials': E CSLB Contractor E ICC Service Tech. ❑SWRCB Tank Tester ❑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: EHydrostatic []Vacuum ❑Other <br /> Test Equipment Used: Visual Measure Equipment Resolution: 1/16" <br /> Identify Spill Bucket(By Tank 1 UG0100001 2 3 4 <br /> Number,Stored Product, etc) <br /> ❑Direct Bury []Direct Bury ❑Direct Bury []Direct Bury <br /> Bucket Installation Type: EContained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sump <br /> ❑On Top of AST ❑On Top of AST []On Top of AST E10n Top of AST <br /> Bucket Diameter: 11.00" <br /> Bucket Depth: 14.25" <br /> Wait time between applying <br /> vacuum/water and start of test: 15 Min <br /> Test Start Time(Ti): 11:35 AM <br /> Initial Reading(RI): 13.75" <br /> Test End Time(TF): 12:35 PM <br /> Final Reading(RF): 13.75" <br /> Test Duration(TF—Ti): 1 Hour <br /> Change in Reading(RF-Rj): 0 <br /> Pass/Fail Threshold or 0 <br /> Criteria: <br /> Test Result: E Pass ❑Fail ❑ Pass []Fail ❑ Pass ❑Fail ❑ Pass ❑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:_ 161M &W,61 Date: 02-18-2016 <br /> i 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 />