Laserfiche WebLink
FROM : OIL EQUIPMENT PHONE NO. : 209 7545726 Jan. 16 2003 04:49AM P2 <br />page _1 of $ <br />S%'RC:13, January 2002 <br />Secondary Containment Testing Report Form — FINAL. DRAFT <br />I'htY J.,rai 1ti Int ai 1ccl J,n ieYU try C.nrtrau lo— pt'rJr„ruing periodic Gcvlinh .rf 11.ST screnrulury cv»tlulnnt<:nt .5'yctam.c, t13C the <br />s, and <br />tappropriatc pages of this f rrm to repur-t r�aulrs fur all components tested- The completed form, written rest pr`ucedure <br />printouts from tests (if appltepble), should be provided to the facility Own er/operator• for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Date ofTestin <br />lacilityName: Valley. Pacific Camilo k <br />Facility Address: 1 524 Fresnor Ave,, Stockton CA <br />Facility Contact: Mike IS] iasozl�pltonc' 209-948-941 2 <br />Date Local Agency Was Notified of Testing: 10/8/02 <br />Name of i.ocal Agency Inspector (if t>rese�!it �herPrTb testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: oil juipinent Service <br />Technician Conducting Test: James P. Hesketh _ <br />Credentials. 5f CSC.D Licensed Contractor LI SWRCE Licensui Tank Tester <br />iccnse '1'ypc: A H a z C61/1)40,C10, C 5 7 License Numb(z: 32341-7 <br />L <br />Manor cturer TraiRinQ <br />Manufacturer Com oncnt s) llatc Training 1 xpires <br />Modern Weldin Tank 6/10/()A <br />19/0 <br />3. SUMMARY <br />Component Paas <br />OF <br />Not <br />Fail Tested <br />TF-ST'RLSUL <br />Repairs <br />Made <br />l h <br />Component <br />Pass Fail <br />Not Repairs <br />Teated Made <br />Tank Annular U <br />Secondary Pipe <br />U <br />U <br />I1 <br />i.J U <br />U <br />U U <br />.. Lf U <br />U U <br />U U <br />U U <br />Dispenser. Pans., l l <br />pilDe Sum 1] <br />t_i <br />U LY <br />Ll LX <br />iii iJ <br />U <br />_ <br />U <br />i_1 U <br />u U <br />L U <br />L u <br />,I 1-1U <br />L.I U <br />U <br />_ <br />U U <br />U U- <br />J <br />U U� <br />u u <br />I <br />u U <br />Li <br />U �� <br />U U <br />u <br />U <br />U LI <br />Li II <br />Lj <br />U <br />U U <br />U U <br />L <br />U u <br />u <br />U u <br />u u <br />L <br />u U <br />u <br />u u <br />u u <br />if hydrostatic testing was performed, describe what was done with the water after completion of tests' <br />Secondary Contianment Ezaviron pipe termination test fitt?n_s <br />are not in place. Need to remove di5 erasers from islands �o repair <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCCING 'PHIS TESTING <br />To the best of my Anowtedge, the facts stated in this document are accurate and in full Compliance with legal requirements <br />Technician's Signature: <br />/ ', Date: 12/17/02 <br />J mes P. Hesketh <br />by: Marleen K. Jose$, <br />Office Manager <br />