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c-'WRCB,January 2002 Page_of 4 <br /> Secondary Containment Testing Report Form <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate <br /> pages of this form to report results for all components tested. The completedform, written testprocedums, andprintouts from tests(f <br /> applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> I, FACILITY INFORMATION <br /> Facility Name:SPRINT STOCKTON SWITCH Pate of Testing: 11/19/2008 <br /> Facility Address:3807 CORONADO AVE,STOCKTON,CA 95204 <br /> Facility Contact:KEN CARR hone:209 937-5800 <br /> Date Local Agency Was Notified of Testing: 10/25/2008 <br /> Name of Local Agency Inspector(f present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> ompany Name: LeMesnager Engineering <br /> echnician Conducting Test:Rene LeMesnager <br /> redentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> icense:Engineering A,HAZ icensc Number:203029 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Ex ires <br /> ncon TS-STS Oct 1, 2010 <br /> Vacuum w/4"gauge <br /> ressure w/4"gauge <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Annular(Brine Filled)UST J <br /> Secondary Lines UST(2) d <br /> Piping Sump UST(1) <br /> Spill Bucket UST(1) <br /> Secondary Lines AST(2) <br /> Transition Sump AST(1) <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Water is transported from site to site. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: Date: 11/19/2008 <br />