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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:TESORO/SPEEDWAY#68153 Date of Testing: 5/22/2025 <br /> Facility Address:2448 WEST KETTLEMAN LANE,LODI,CA 95242 <br /> Facility Contact: Phone:- <br /> Date Local Agency Was Notified of Testing:3/25/2025 <br /> Name of Local Agency Inspector(if present during testing):na <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test: Steve Willems <br /> Credentials I: W CSLB Contractor ICC Service Tech. r— SWRCB Tank Tester r— Other(Specify) <br /> Licensc Number(s):743160 <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: Hydrostatic R Vacuum F Other <br /> Test Equipment Used:VACUUM TEST Equipment Resolution:0.1 gph <br /> JL <br /> Spill Box#Tank T-1 Spill Box#Tank T-2 Spill Box#Tank T-3 Diesel <br /> Identify Spill Bucket(By Tank REGULAR-Fill I-Direct- PREMIUM-Fill 1-Direct- -Fill I-Direct-Grade level Spill Box# <br /> Number, Stored Product, etc) Grade level in containment Grade level in containment <br /> in containment sump <br /> sump sump <br /> Bucket Installation Type: rDirect Bury C Direct Bury r Direct Bury C Direct Bury <br /> C: Contained in Sump C Contained in Sump !: Contained in Sump C Contained in Sump <br /> Bucket Diameter: 12.00 12.00 12.00 <br /> Bucket Depth: 16.00 15.50 14.75 <br /> Wait time between applying 1 min I min 1 min min <br /> vacuum/water and start of test <br /> Test Start Time(TI): 10:30:00 10:35:00 10:40:00 <br /> Initial Reading(RI): 30.00 in.H2O 30.00 in.H2O 30.00 in.H2O <br /> Test End Time(Tg): 10:31:00 10:36:00 10:41:00 <br /> Final Reading(Rp): 30.00 in.H2O 27.00 in.H2O 26.00 in.H2O <br /> Test Duration(TF—TI): 1 min I min 1 min <br /> Change in Reading(RF—RI): 0.00 in.H2O -3.00 in.H2O -4.00 in.H2O <br /> Pass/Fail Threshold or Criteria: +/-4.00 +/-4.00 +/-4.00 +/- <br /> Test Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <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: 5/22/2025 <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:2379677 <br />