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ILII (i a 8VICi$, January 2006 Spill Bucket Testing Report Form ENVIRONMENTAL This form is intended for use by contractors per for ming annual testing of UST spill containment1rc#a�r4e T fltV jq4 �' form and printouts from tests (f applicable), should be provided to the facility owner/operator for• submittal to he ocal regulatory agency. 1 FA('TT,TTV TNFfIRMATTnN Facility Name: Facility Address: SAN JOAQUIN DOWNTOWN GARAGE Date of Testing: 7-25-18 121 S SAN JOAQUIN ST Facility Contact: ROBERT Phone: 209-468-2068 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): AARON 2. TFSTTNG CONTRACTOR INFORMATION Company Name: AFFORDA TEST 416 2"d Street Galt, CA 95632 (209) 744-0112 Fax: (209) 744-0116 Technician Conducting Test: ❑ Ed Stearns ❑ Zane A. Nimmo ® David A. Winkler ❑ Felix G. Ramirez 8883080 -UT 8883064 -UT 8883059 -UT 8883072 -UT Credentials': ®ICC Service Tech. ®SWRCB Tank Tester 3. CPTT,T, RTTC"KFT TFSTTNG TNFnRMATION Test Method Used: ®Hydrostatic ❑Vacuum E] Other Comments — (inchrde information on repairs made prior to testing, and recommended folloly-up far• failed tests) OPW BUCKETS EXTRA LARGE BUCKET CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: W Date:7-27-16 � State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent. Test Equipment Used: TAPE / H2O Equipment Resolution: 1/16 Identify Spill Bucket (By Tank Nwnber, Stored Product, etc. 1 87 2 ❑ Direct Bury ❑Contained in Sump 3 ❑ Direct Bury El Contained in SumpSum 4 ❑ Direct Bury E] Contained in Bucket Installation Type: ® Direct Bury ❑Contained in Sump Bucket Diameter: 17 Bucket Depth: 22 Wait time between applying vacuum/water and start of test: Test Start Time (Ti): 12 Initial Reading (RI): 21 Test End Time (TF): 1 Final Reading (RF): 21 Test Duration (TF — TI): 1 HOUR Change in Reading (RF - RI): 0 Pass/Fail Threshold or Criteria: Test Result: ® Pass ❑ Fail ❑ Pass ❑Fail ❑Pass ❑ Fail ❑ Pass ❑ Fail Comments — (inchrde information on repairs made prior to testing, and recommended folloly-up far• failed tests) OPW BUCKETS EXTRA LARGE BUCKET CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: W Date:7-27-16 � State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more stringent.