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SWRCR,January 2002 Page 1 of 7 <br /> Secondary Containment Testing Report Form <br /> Stockton Service Station .Equipment CO., Inc. <br /> 808 N. Union Street, Stockton, CA 95205-4152 (209)464-8333 FAX (209)464-8349 <br /> CalifomiacontractorLicense309105A-C61/D40HA7JHIC E-mail S..cco(c�tarbell.nct <br /> 1. FACILITY INFORMATIO Date of Testing: 09.22.10 <br /> T"'o ]�ST�"e"$P <br /> RANORT GA 952067611 S.AIORT WAX STOCICTOPt, phone: 714-893-6140 <br /> Jm Eunck Was Notified of Testin 09.15.10lenc Ins ctor if resent dtutin testin <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Com an Neme: Stockton Service Station E I1 men <br /> Technician Conducnn Test: Eric Mol acrd SWRCB Licensed Tank Tester <br /> Credentials: X CSLB Licensed Contractor License Number: 309105 <br /> License Type: C-61ID40 HAVRIC <br /> Manufacturer Training <br /> Com onen s Date Training Expires <br /> M <br /> anufacturer N/A <br /> s Products C�03man <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repair <br /> Component pass Fall Not Repairs Component Pass Fpll Tested Made <br /> Tested Made <br /> Sccooda PI Testin Pa e3 X <br /> Pi in Sum Testin .Pa e4 X <br /> tlnder•Dis enur Contain.Pa c 5 X <br /> Ir hydrostntic testing was performed,describe what was done with the water alter completion of tests: <br /> Approximately 200 gallons contaminated water put into drums for Cert'if'ied Waste Hauler to pie <br /> up. <br /> Pages 2,6, 7 N/A <br /> CERTIFICATION OF'I'ECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge, the facts stated in this document are accurate and in Rill compliance with legal requirements. <br /> Technician's Signature: E a NoCCaard Date: 09.22.10 <br />