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S WRCB,January 2002 Page of <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 <br /> appropriate pages of this farm to report results for all components tested The completed form, written test procedures, and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: A G Spanos Jet Center Date of Testing: February 27,2018 <br /> Facility Address: 4800 South Airport Way,Stockton,Ca.95206 <br /> Facility Contact: Thomas Tilley I Phone: (209)982-1550 <br /> Date Local Agency Was Notified of Testing: 1/23/2018 <br /> Name of Local Agency Inspector(ifpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Afford-a-test <br /> Technician Conducting Test: Benjamin F.Duncan Jr./ICC#5246802-UT <br /> Credentials: X CSLB Licensed Contractor X SWRCB Licensed Tank Tester <br /> License Type: A License Number: CSLB Lie.#341375/SWRCB Lia 990-1120 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date I raining Expires <br /> Caldwell Systems Piping Sumps/Transition Sumps/Return Sums July 5,2020 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Annular Tank#1 X ❑ ❑ ❑ Return Piping Sump#2 X ❑ ❑ ❑ <br /> Annular Tank#2 X ❑ ❑ ❑ Transition Piping Sump #1 X ❑ ❑ ❑ <br /> Annular Tank#3 X ❑ ❑ ❑ Transition Piping Sump #2 X ❑ ❑ ❑ <br /> Secondary Pipe#1 X ❑ ❑ ❑ Transition Piping Sump#3 X ❑ ❑ ❑ <br /> Secondary Pipe #2 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Secondary Pipe #3 X I ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Secondary Pipe #4 X ❑ ❑ ❑ ❑ ❑ ❑ LI— <br /> Secondary <br /> Secondary Pipe #5 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> STP Piping Sump#1 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> STP Piping Sump#2 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> STP Piping Sump#3 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Return Piping Sump#1 X ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Test Fluid Supplied and Recovered for reuse. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,ffthe facts stated <br /> diin'this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: .�fk 3e - J`. e//u�rcaaa Date: February 27,2018 <br />