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SWRCB, Januaiy 2006 <br />1. FACILITY INFORMATION <br />Date of Testing: 2/7/2024 <br />Phone: 209-8300370 <br />2. TESTING CONTRACTOR INFORMATION <br />F SWRCB Tank Tester F" Other (Specify) <br />I- Other <br />Spill Box #Spill Box # <br />Bucket Installation Type: <br />Bucket Diameter:12.00 12.00 <br />16.00 16.00 <br />1 min 1 min min min <br />08:00:00 08:02:00 <br />30.00 in. H20 30.00 in. H20 <br />08:01:00 08:03:00 <br />30.00 in. H20 30.00 in. H20 <br />1 min 1 min <br />0.00 in. H20 0.00 in. H20 <br />+/-4.00 +/- 4.00 +/-+/- <br />Pass PassTest Result: <br />Comments - (include information <br />Date: 2/7/2024 <br />Identify Spill Bucket (By Tank <br />Number, Stored Product, etc.) <br />C Direct Bury <br />(* Contained in Sump <br />Spill Box# Tank T2 <br />REGULAR-Fill 1 - Direct- <br />Grade le\ el in containment <br />sump <br />C Direct Bury <br />(* Contained in Sump <br />Spill Box# Tank T 1 <br />PREMIUM-Fill 1 - Direct- <br />Grade level in containment <br />sump <br />C Direct Bury <br />C Contained in Sump <br />C Direct Bury <br />C Contained in Sump <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 />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 />Bucket Depth: <br />Wait time between applying <br />vacuum/water and start of test <br />Test Start Time (Tj): <br />Initial Reading (Rj): <br />Test End TimeCTp): <br />Final Reading (Rp): <br />Test Duration(Tp-T|): <br />Change in Reading (Rp-Rj): <br />Pass/Fail Threshold or Criteria: <br />Facility Name: CHEVRON #208117__________________________ <br />Facility Address: 755 S. TRACY BLVD, TRACY. CA 95376_______ <br />Facility Contact: Diane Province <br />Date Local Agency Was Notified of Testing: 1/30/2024 <br />Name of Local Agency Inspector (if present during testing): PAUL <br />_____ 3. SPILL BUCKET TESTING INFORMATION <br />Test Method Used By: ~ Hydrostatic 1*^ Vacuum <br />Test Equipment Used: VACUUM TEST Equipment Resolution: 0.1 gph <br />on repairs made prior to testing, and recommended follow-up for failed tests) <br />Technician's Signature: fMe. <br />'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: 2364478 <br />Company Name: TANKNOLOGY INC. <br />Technician Conducting Test: Jesus Saldivar <br />Credentials1: I” CSLB Contractor I** ICC Service Tech. <br />License Number(s):