COMPLIANCE INFO 1994-2010 - Laserfiche WebLink

Home Browse Search

J_ ,7n 23 06 08:16p Me Dotten 20533-2650 Alltech 17759 Buttercup Circle Sonora, CA 95370 209-532-7320 Secondary Containment Testing Report Fort 1. FACILITY INFORMATION p.1 Facility Name: Madsen's Dairy Date of Testing: Friday, January 06, 2006 Facility Address: 239 S. Stockton Rd., Ripon CA 95358 Facility Contact: Bob Madsen Phone: 599-3041 Date Local Agency Was Notified of Testing : Not sure at this point. Name of Local Agency Inspector ffpresent during testing): Willy Ng 2. TESTING CONTRACTOR INFORMATION Company Name: Alltech Petroleum Services Technician Conducting Test: Mike Dotten Credentials: ® CSLB Licensed Contractor ®SWRCB Licensed Tank Tester License Type: A, Haz License Number: 623541 Manufacturer Training Manufacturer Com onent s Date Training Expires Incon Sump Tester ! fin cJ ?� •r ' a= C&yz 7i Gt 6Y» 3. SUMMARY OF TEST RESULTS Component Pass FailNot Tested Repairs Component Made Pass pal Not Tested Repairs 1 Made Diesel fill ill near the street Annular (shared) Z ❑ ❑1 ❑ Diesel UDC near the street ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ Regular fills ill ❑ ❑ ❑ ❑ ❑ Regular UDC z ❑ ❑ ❑ ❑ ❑ Diesel fills ill Ej❑ ❑ Duesel UDC E 0 1❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: Water from all tests was placed in a barrel that was already on site. The barrel was marked with a Hazardous Materials label and left on site. i1rr21Z F-1 L L S f i ti_ /.1 ET�DED -174+ A-64PTAF) -n A1kr;7.I M C9 -l/ MT7 to CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, rhe fac�(g stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Y E, Date: