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belshire 25971 Towne Centre Drive <br /> Foothill Ranch , CA 92610 <br /> environmental services, Inc. ( 949 ) 460 - 5200 <br /> Spill Bucket Integrity Testing — Fill Buckets <br /> Hydrostatic Testing Method <br /> Facility : Costco Wholesale - TRACY - 0658 Date : 9/24/2020 <br /> Address : 3250 W . Grantline Rd Testing Company: Belshire Environmental Services <br /> City, State, Zip : Tracy , CA 95377 Tester Name : Jeff Badders <br /> This test is performed in accordance with PEI/RP1200 . See Section 6 . 2 for the test method and procedures . <br /> Fill Bucket ID 91 Add 1 Add 2 T1 87 T2 87 <br /> Manufacturer PhilTite PhilTite PhilTite PhilTite PhilTite <br /> Inside Diameter 12 " 12 12 12 " 12 " <br /> Inside Depth 14 " 14 " 14 " 14 " 14 " <br /> Capacity 5 Gallons 5 Gallons 5 Gallons 5 Gallons 5 Gallons <br /> Construction Single Wall Single Wall Single Wall Single Wall Single Wall <br /> (single or Double Wall ) <br /> Cathodic Protection <br /> ( Isolation or Non- Metallic) Non -Metallic Non - Metallic Non - Metallic Non -Metallic Non - Metallic <br /> Liquid Removal Method Drain Valve Drain Valve Drain Valve Drain Valve Drain Valve <br /> ( Drain valve , Pump or NA) <br /> Liquid or debris removed Yes Yes Yes Yes Yes <br /> from spill bucket?' <br /> Visual Inspection' Pass Pass Pass Pass Pass <br /> Tank Riser Cap Included in <br /> Test Yes Yes Yes Yes Yes <br /> Drain Valve Included in Test Yes Yes Yes Yes Yes <br /> Test Start Time 05 : 31 AM 09 : 16 AM 09 : 16 AM 06 : 04 AM 05 : 31 AM <br /> Starting Water Level 3 . 9451 6 . 4663 6 . 386 3 . 6447 2 . 7773 <br /> Test End Time 05 : 46 AM 09 : 31 AM 09 : 31 AM 06 : 19 AM 05 : 46 AM <br /> Ending Water Level 3 . 9447 6 . 466 6 . 386 3 . 6446 2 . 7773 <br /> Water Level Change -0 . 0004 -0 . 0003 0 . 0000 - 0 . 0001 0 . 0000 <br /> Test Period 15 15 15 15 15 <br /> Pass/fail criteria : Must pass visual inspection . Water level drop of less than 1 /8" . <br /> Test Results : WPass E] Fail WPass [-] Fail [,Pass ❑ Fail W Pass ❑ Fail ❑v Pass ❑ Fail <br /> Comments : <br /> 'All liquids and debris must be disposed of properly. <br /> # No cracks, loose parts or separation of the spill bucket. <br /> Technician Signature : Date : 9/24/2020 <br /> Rev. 9/28/2018 <br />