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RECEIVED <br />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 comp e�f� <br />° <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local re ul�'� <br />1. FACILITY INFORMATION <br />Facility Name: 7 -ELEVEN #32262, MKT 2368 (N-3940-1 I Date of Testing: 3/3/2016 <br />Facility Address: 2360 W GRANTLINE I-205 OFF RAMP, TRACY, CA 95376 <br />Facility Contact: CHANDRA Phone: 209-830-9917 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY INC. <br />Technician Conducting Test: Nicolas Poblano <br />Credentialst : Ml CSLB Contractor 17" ICC Service Tech. M SWRCB Tank Tester F! Other (Specify) <br />License Number(s): <br />3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used By: Hydrostatic r7. Vacuum Other <br />Test Equipment Used: VPLT Equipment Resolution: <br />0.00001 in. <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />Spill Box # Tank T4 RUL . <br />REG UNLEAD - Fill 1- <br />Direct -Grade level in <br />containment sump <br />= Spill Box # Tank T5 MUL <br />MIDGRADE - Fill 1 - Direct <br />-Grade level in <br />containment sump <br />Spill Box # Tank T6 PUL <br />PREMIUM - Fill 1 - Direct - <br />Grade level in containment <br />sump <br />Spill Box <br />Bucket Installation Type: <br />Direct Bury <br />l+ Contained in Sump <br />r Direct Bury <br />ro Contained in Sump <br />f 7 Direct Bury <br />Io Contained in Sump <br />r Direct Bury <br />C Contained in Sump <br />Bucket Diameter: <br />10.50 <br />10.50 <br />10.50 <br />Bucket Depth: <br />16.00 <br />16.00 <br />13.25 <br />Wait time between applying <br />vacuum/water and start of test <br />5 min <br />5 min <br />5 min <br />min <br />Test Start Time (TI): <br />09:48:00 <br />12:00:00 <br />11:13:00 <br />Initial Reading (Rt): <br />14.50 in. <br />14.50 in. <br />12.25 in. <br />Test End Time(TF): <br />09:48:00 <br />12:10:00 <br />12:13:00 <br />Final Reading (RF): <br />14.50 in. <br />13.00 in. <br />12.25 in. <br />Test Duration(TF—Tl): <br />1 hr <br />10 min <br />1 hr <br />Change in Reading (RF—RI) : <br />0.00 in. <br />-1.50 in. <br />0.00 in. <br />Pass/Fail Threshold or Criteria: <br />+/-0.00 <br />+/-0.00 <br />+/-0.0077 <br />Test Result:, <br />Pass <br />Fail <br />Pass <br />Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />Spill bucked 89 grade failed after inspection of bucket found that jack screw assembly was damaged. needs to be repaired and retested. <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 <br />Date: 3/3/2016 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. <br />WO: 2325965 <br />