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.05/06/2013 01:48PM 6616349233 KERN CONSTRUCTION PAGE 01103 <br />RECEIVED <br />SWRCB, January 2002 Page _j_ of <br />Secondary Containment Testing Report Form o 2013 �p <br />This form is intended for use by contractors performing periodic testing of UST secondary 6 "� <br />appropriate pages of this form to report results for all components tested The completed forih(E�;p nd <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: Valley Pacific Petroleum Date of Testing: April 5, 2013 <br />Facility Address: 1524 Fresno Ave., Stockton, CA <br />Facility Contact: Mike Eliason Phone: <br />Date Local Agency Was Notified of Testing: April 2, 2013 <br />Name of Local Agency Inspector (/present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Kern County Construction, Inc. <br />Technician Conducting Test: Josh Simmons <br />Credentials: x CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br />License Type: A, B, Haz <br />License Number:481053 <br />Manufacturer Training <br />Manufacturer Component(s) Date Training Expires <br />3. SUMMARY OF TEST RESULTS <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water was placed in drunn onsite. <br />CERTIFICATION OFT HNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the fact st ed in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: Date:_ yy/3 <br />Satellite #1 Secondary ©000 <br />ooc�o <br />0000� <br />oo■�oi <br />®©aa <br />0000i <br />v©oo <br />©000; <br />ao©o <br />0000 <br />0000 <br />000■t.� <br />0000; <br />0000 <br />0000 <br />0000' <br />oor�o <br />novo <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water was placed in drunn onsite. <br />CERTIFICATION OFT HNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the fact st ed in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: Date:_ yy/3 <br />