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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 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 <br /> Facility Name: FED EX FACILITY Date of Testing: 8-28-18 <br /> Facility Address: 953 HOOD WAY TRACY CA. <br /> Facility Contact: Phone: 209-839-2060 <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: Franzen-Hill <br /> Technician Conducting Test: MARK WILLIAMS <br /> Credentials': X CSLB Contractor X ICC Service Tech. ❑SWRCB Tank Tester ❑Other(Spec) <br /> License Number(s): A304147 8198890-UT <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used: X Hydrostatic ❑Vacuum ❑Other <br /> Test Equipment Used: VISUAL Equipment Resolution: .0 1 <br /> Identify Spill Bucket(By Tank 1 2 3 4 <br /> Number, Stored Product, etc.) B99 <br /> Bucket Installation Type: ❑ Direct Bury ❑Direct Bury ❑Direct Bury ❑ Direct Bury <br /> X Contained in Sump ❑Contained in Sump ❑Contained in Sump ❑Contained in Sum <br /> Bucket Diameter: 12" <br /> Bucket Depth: 18" <br /> Wait time between applying 15 MIN <br /> vacuum/water and start of test: <br /> Test Start Time(Ti): 1:00 PM <br /> Initial Reading(RI): 11" <br /> Test End Time(TF): 2:00 PM <br /> Final Reading(RF): 11" <br /> Test Duration(TF—Tj): 1 HRS <br /> Change in Reading(RF-RI): 0" <br /> Pass/Fail Threshold or 0 TOLERANCE <br /> Criteria: <br /> Test Result: X 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 /> REPLACED B99 SPILL BUCKET WITH OPW SPILL BUCKET AND <br /> HYDROSTATICALLY TESTED PASSED <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:-8-28-18 <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 />