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SWRCB,January 2002 Page of Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested The completed form, written test procedures, and printouts from tests(if applicable), should be provided to the facility ownerloperator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: A G Spanos Jet Center I Date of Testing: February 29,2012 Facility Address: 4800 South Airport Way,Stockton,Ca.95206 Facility Contact: Thomas Tilley I Phone: (209)982-1550 Date Local Agency Was Notified of Testing: 2/27/2012 by Afford-A-Test Name of Local Agency Inspector(rf present during testing): Muniappa Naidu, Senior,R.E.H.S. 2. TESTING CONTRACTOR INFORMATION F ompany Mame: R&D Compliance Testing echnician Conducting Test: Benjamin F.Duncan Jr. redentials: IJ CSLB Licensed Contractor X SWRCB Licensed Tank Tester License Type: Tank Tester License Number: 90-11201ICC#5246802-UT Manufacturer Training Manufacturer Component(s) Date Training Expires 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component Pass Fail Not Repairs Tested Made Tested Made Secondary Pipe#I X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ I ❑ ❑ ❑ ❑ ❑ If hydrostatic testing was performed,describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: February 29,2012