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I <br />FROM :Donlee pump Co. <br />• FAX NO. :2095379398 <br />dian. 27 2009 01:50PM P2 <br />SWRCB, Jaauary 2002 Page! .., or -OP <br />Secondary Containment Testing Report Form <br />77us,/urm is intended fix use by camractors peryorming pertadic testing afY/ST secronawry carotalnnveM systems. (lve the <br />appropriale paves of this form to report results fur all components tested The completed form, wriaon test proveduml, and <br />1-wiMaalB from tests (If oppl/eablc), shau/d be provided to the factliry nwtrer/ryreramr•, fier,nbmllru! ro the agency, <br />L FAG L-ITY INFORMATION <br />Facility Nmnb = s Date ofTestlny;1p�V �_.. ..__. <br />Date Lotut — — — <br />Facility A.._.... <br />------I A Imc W <br />Facility ntact <br />.' C l <br />g Y. Notlfled ofTestln <br />Js : I- <br />'lama of Local AQenc Ins actor (tf present Barin tcstirw: <br />�• � as r snu can rKAC.I VK INlVKMA'PIUN <br />Cotnpuny Name: Do <br />Technician ConductlnQ T'tec • k P l _ <br />Credentials: 1 I CS1,B Licensed Contractor I I yWRCS Licensed Tank Tester <br />LicenseT e;'�cl.G LiceueNuakw: <br />3. SUMMARY <br />OF TEST <br />RESULTS <br />Compeneat <br />.....--.--- ---- <br />�,1i.. rL�ii L_. y <br />;fQl....PAS' 71.0 JYi.. .l,.--- <br />t11Ae. .....—..—. <br />_..._... ... <br />_ <br />Pass <br />Full <br />.__.._ <br />Nd <br />7•aw11 <br />Repa4a <br />Made <br />Carapsaaat <br />�„ <br />Faa <br />. Not <br />IMtad <br />Repairs <br />Made <br />---...._ <br />-- --- .... -- <br />r:! <br />I.I <br />n <br />L... <br />_�...n <br />.n <br />CI <br />u <br />__ I.... <br />n <br />._ f,.! <br />u <br />fa <br />n. <br />G <br />I <br />K <br />44 <br />LI <br />I I <br />1'.1 <br />i_I <br />❑ <br />L.I <br />L <br />� I <br />rl <br />,I . . <br />u <br />.i:!._ <br />CI <br />. I <br />Il...._n._ <br />IJ <br />rJ <br />I Gl <br />1 11 <br />n <br />0 <br />F1 <br />n _. <br />_ <br />u <br />u <br />j <br />:1 <br />— <br />FI <br />IV s: _ <br />. _ <br />"y roa uuc t� nuWus P ur� , d � rwhat was done with the water altar wm jkpon�afltest, <br />('1?R'nv&vATION OF TECHNICIAN RC6PONSIBUr FOR CON Dl1C17NG—JI11S'ITw9'1'tNG <br />To the hest df My kaowlt**, the fico staved In /1ds docunlew are actwntte and /n fall complinnc•e Iwilb lavolwrelpfiremvMa <br />Technician's tiignntare:,$(/� ..41(.. ___... Date: ``oU <br />