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SWRCB, January 2006 Spill Bucket Testing Report Form This form is intended for use 1)1•contractors pel-lol-ming annual testing 0f UST spill containment structures. The completed form and printouts fi-0177 tests (if applicable) should be provided to thefacility ow ner/operator for submittal to the local r•egulatort,agency. I. FACILITY INFORMATION F�aciName: UNITED#5446_ — Date of Testing: 5/1118 ddress: 1403 COUNTRY CLUB BLVD, STOCKTON, CA 95204 ontact: TOM ROBINS — Phone: (310) 930-5415 Date Local Agency Was Notified of Testing:_ 4/24/18 Name of Local Agency Inspector(if present during testing): COUNTY OF SAN JOAQUI (INSPECTOR _ 2. TESTING CONTRACTOR INFORMATION Company Name: TANK-TEK ENVIRONMENTAL CORPORATION Technician Conducting Test: ENRIQUEAGUIRRE — Credentials: ❑ CSLB Contractor ❑ ICC Service Tech. ❑ SWRCB"Lank Tester ❑ Other(Specify) License Number(s): 803705 —_— 3. SPI_L_, BUCKET TESTING INFORMATION Test Method Used: ® Hydrostatic — --� Vacuum----_— []Other(Specffj) —— _ Test Equipment Used: VISUAL - TAPE MEASURE - Equipment Resolution: 1/16" Identify Spill Bucket (Bi- Tank Nu7uber, Stored Product, e1c.) 87 FILL 91 FILL DIESEL FILL WASTE OIL FILL Bucket Installation Type: ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ❑ Direct Bury ® Contained in Sump ® Contained in Sum — _ p ® Contained in Sump ® Contained in Sump Bucket Diameter: — 12" -_ 12" 12" 12" Bucket Depth: 12" 12" 12" 12" Wait time between applying — vacuum/water and start of test: 30 MIN 30 MIN 30 MIN 0 Test Start Time(Ti): 1:30 1:30 1:30 Initial Readin- - ---- — (Ri) 10.50" 10.50" 10.50" - ------------ est End Time(Tr)_ 2:30 2:30- 2:30 Final Reading(RF): 10.50" ------- - --- 10.50" 10.50" Test Duration (Tr-Ti): 1 HR 1 HR 1 HR Chane in Reading(R,:-Ri): 0 - - p ---- -_-- - ----- -- { Pass,Tail Threshold or Criteria: +/-0.002" +/-0.002" +/-0.002" +/-0.002" Test Result: —® Pass -- E] Fail ®-Pass _ ❑ Fail ® Pass ❑ Fail ❑ Pass ® Fail Comments - (include information on repairs made prior to testing, and recommended follow-up for failed tests) WASTE OIL FILL FAILED-RIPPED FROM THE RUBBER TOP-NEED TO REPLACE AND RETEST CERTIFICATION OF TECHNICIAN RESPONSIBLE, FOR CONDUCTING THIS TESTING !hereby cert lfjl that all the information contained in this report is true, accurate, and in full compliance with legal requirements. Technician's Signature: Date: 5/1/18 State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements may be more strin�-yent.