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U <br />At �JFN, August 2003 <br />HEGEIVEL,,, <br />'P <br />Secondary Containmtot Testing Report f. 1�IR��IIV1EN`l A, <br />This form is inlend¢d Jor use by (nspecllnn stuff1)erfar•mb:g testing during installation of ll,ti7'secorulury contpfnImnf ,7 110 1s, . �T, r T <br />appropriate pages of this form to report results for all components tasted. The completed forms. written test pracedut es, and printouts f►�rnrrles�s <br />(lf applicable), shall be used In evaluating the installation of new equipment and repairs to exl,Yfingequipment, <br />1. FAULITY INFORMATION <br />Facillty Nurse 1» fate pC'iestin l: <br />�Fa�cijjjyddress: Wontact: <br />Date local Agency Wxt Notified of 'Testing : <br />Name ufLocal Agcncy b3spector (present during; testinP)} <br />2. TES`rjr,4G CONTRACTOR 11NFORMA,TIUN <br />Company U.S.T, Compliwice Testing Inc. <br />Technicians Conducting Test:Tony Fontana I Bill McCarthy <br />Credentials: x CSLB Licensed Contractor SWRC;t3 Licensed Tank Tester <br />Uccnso Typc. A Gen. Eng. 9846288 License Number: <br />Manufacturer <br />In -Can <br />Component <br />C nlrnc is n ufacta cr'1'r 'tlin <br />Cortiponcnt(s) <br />STS <br />3. SUMMARY OF TEST RESULTS <br />Nut iupairs Componea, <br />FPI Fnil Tested I Made _. <br />Am"M <br />UaM= <br />Homm <br />Pass <br />WINEoneW <br />Tested <br />-❑ <br />Made <br />❑ <br />❑ <br />Nome <br />❑ <br />N <br />MM <br />❑ <br />100"M <br />Emma. <br />INIE"M <br />E . <br />n <br />❑ <br />Date Train <br />2-022016 <br />If hydrostatic testing was performed, describe what was done with the water after completion of testy: <br />Tt;slirt s lution taken with us to use t next test <br />Inspector's Signaturo: <br />Date: —3_1 ILA <br />1. T 'd 22b289b :01 96LT T2S608 90NUI-1dW00 1Sn : WOd-9 82:9T ST02-c-Wf <br />Itepuirs <br />Pass <br />FallNot <br />Tested <br />-❑ <br />Made <br />❑ <br />❑ <br />❑ <br />Cl <br />❑ <br />❑ <br />1, Z1, <br />rl <br />n <br />❑ <br />❑ <br />_ <br />�[ <br />n <br />❑ _ <br />U <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />u <br />n <br />❑ <br />❑ ... <br />❑ <br />❑ <br />El <br />n <br />If hydrostatic testing was performed, describe what was done with the water after completion of testy: <br />Tt;slirt s lution taken with us to use t next test <br />Inspector's Signaturo: <br />Date: —3_1 ILA <br />1. T 'd 22b289b :01 96LT T2S608 90NUI-1dW00 1Sn : WOd-9 82:9T ST02-c-Wf <br />