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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 /> California Contractor License 109105 A-C61/D40 HAZ/HIC E-mail ksseco&2 acbell_net <br /> 1. FACILITY INFORMATION <br /> Facility Name: ESTES TRANSPORT Date of Testing: 09.22.10 <br /> Facility Address: 7611 S.AIRPORT WAY,STOCKTON,CA 95206 <br /> Facility Contact: Jim Bunck Phone: 714-893-6140 <br /> Date Local Agency Was Notified of Testing: 09.15.10 <br /> Name of Local Agency Inspector if present during testing) <br /> 2. TESTING CONTRACTOR INFORMATION <br /> i (_;v oany Name: Stockton Service Station <br /> Technician ConductingTest: Eric Molgaard - <br /> Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type C 61/D40 HAZ/HIC License Number: 309105 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> Smith Fibetrglass Products Cote N/A <br /> _ 3._SUM_MARY OF <br /> _Com_ __ ___ <br /> ponent Pass Fail fiat—It—Repairs.M _ Pass Component Fail Not Repairs <br /> FS 'rested ade Tested Made <br /> econdary --- <br /> piDing Sump Testing,Page 4 X — -- - <br /> Under-Dis enser Contain.Page 5 x <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Approximately 200 gallons contaminated water put into drums for Certified Waste Hauler to pick <br /> up. <br /> Pages 2, 6, 7 N/A <br /> C'ERTIFIC.%TIO\ OF"I-EC1l.NICLkN RF.SPO.NSIBLE FOR CONDI'CTING TInS"rEsTING <br /> To the best nt-mo knuwledee,the facts stated in this document are accurate and in full compliance with legal requirements. <br /> _ — Toehnician'sSignature rte'9blOf�jatl�c( - -- -Bates 09.22j0------------ <br /> MM <br /> 9:22 10MAY 272011 <br /> SjvN <br /> 3a <br />