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4 <br /> SWRCR, Januhty 2002 <br /> Page 1 of 7 <br /> Secondary Containment Testing Report Form <br /> Stockton Service Station Equipment Co., I11C. <br /> 808 N, Union Street, Stockton, CA 95205-41.52 (209) 464-8333 FAX(209) 464-8349 <br /> California Contractor LieenSe 3O9lO3 A-C:Gi/D40 f rA7.JF[IC E-mail siscco rr) ncbell.net <br /> L FACILITY INFORMATION <br /> Facili Name: RgG <br /> Miguel Market Date of Testis 3-G-2009 <br /> Facility Address: r Way <br /> Facilit Contact; ilva 1'lione: <br /> I <br /> Loca.]A enc 0ed Of Testis : 3-06-09 <br /> Name of l ocal�1 cy Inspector{if proscnt durio testis <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Coin anINnine: Stockton Service Station Equipment Co., Inc, <br /> Technicindtin CredentiaCSLB Licensed Contractor <br /> License'1C 61/040 HA7/HIC -- t SWRCB Licensed Ta.nlc Tester <br /> License Number: 309105 <br /> Manufacturer Trainin <br /> Ma>iufacttlrer Components) Date Trainin Fx ires <br /> 3. SUMMARYOF TEST RESULTS <br /> C€�ttaponent 11819 ran Not Repairs Contponent Pass I"'nil Not ltcpnlrs <br /> Te.9ted Mattie Tested Made <br /> Lint SccUn str)' Re Our( x <br /> Vent Lint:Seeoriilnry Sn cr T�nit X <br /> If hydrostatic tcstiltg was performed,degcribe what was done with the water after completion of tegtq: <br /> r.ERTIf+ICATION Of TEC14NICIAN RE PONSI[iLE FOR CONDU(.I')N(:Tr-rrq TESTING <br /> To the best of ixty knowledge, the facts stated in this document arc accurate and in fall compliance witlt legal requirement-s, <br /> Techniciarl's Sigtlat.Liye: lastte: <br /> -0 <br />