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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:7 ELEVEN 35355 Date of Testing:2/13/2026 <br /> Facility Address:3202 W HAMMER LANE(N-136),STOCKTON,CA 95209 <br /> Facility Contact:MANAGER Phone:209-951-3345 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing):Maria Lopez <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Jesus Saldivar <br /> Credentialsl: F CSLB Contractor FV- ICC Service Tech. F SWRCB Tank Tester F- Other(Specifv) <br /> License Number(s): <br /> 3. SPILL BUCKET TESTING INFORMATION <br /> Test Method Used By: F Hydrostatic F vacuum r- Other <br /> Test Equipment Used:LAKE TEST Equipment Resolution:0.0625 in. <br /> Spill Box#Tank Tl: Spill Box#Tank T2: Spill Box#Tank T3:Diesel <br /> Identify Spill Bucket(By Tank Regular RUL-Fill 1 -Direct Premium PUL-Fill 1- Diesel-Fill 1-Direct- Spill Box# <br /> Number, Stored Product, etc) -Grade level in Direct-Grade level in Grade level in containment <br /> containment sump containment sump sump <br /> C Direct Bury C Direct Bury C Direct Bury f Direct Bury <br /> Bucket Installation Type: r: Contained in Sump r• Contained in Sump r• Contained in Sump r Contained in Sump <br /> Bucket Diameter: 12.00 12.00 12.00 <br /> Bucket Depth: 15.00 15.00 15.00 <br /> Wait time between applying <br /> vacuum/water and start of test 5 min 5 min 5 min min <br /> Test Start Time(Tl): 09:00:00 09:00:00 09:00:00 <br /> Initial Reading(Rl): 15.00 in.H2O 15.00 in.H2O 15.00 in.H2O <br /> Test End Time(TF): 10:00:00 10:00:00 10:00:00 <br /> Final Reading(RF): 15.00 in.H2O 15.00 in.H2O 15.00 in.H2O <br /> Test Duration(TF-TI): 1 hr 1 hr 1 hr <br /> Change in Reading(RF-RI): 0.00 in.H2O 0.00 in.H2O 0.00 in.H2O <br /> Pass/Fail Threshold or Criteria: +/-0.00 +/-0.00 +/-0.00 LTest Result: Pass Pass Pass <br /> Comments-(include information on repairs made prior to testing, and recommended follow-up for failed tests) <br /> CERTIFICATION OF TECBMCIAN 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: 2/13/2026 <br /> 1 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:2387902 <br />