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From: 01/27009 17:02 #347 P.002/011 <br />C O'Ifl ,T'[i w C T 0 A 9 <br />s ,r <br />Secondary Containment & Overfill Containment <br />'Vesting Report Form A <br />1. FACILITY INFORMATION <br />Facility Name: Ryder 1071A Date 1;13/09 <br />Facility Address: 3633 Duck Creek Rd. Stockton, CA. <br />Facility Contact: John Luna Phone: <br />Date Local Agency Was Notified of Testing: 1/9109 <br />Name of Local Ageacy Inspector (ifprese>nt during lusting): Ray Von Flue <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Balch Petroleu n Contractors & Builders, Inc. <br />Technician Conducting Test: Elmer Mortera <br />Credentials: X CSLB Licensed Contractor : i SWRCB Licensed Tank Tester <br />License Type: A / B / C-10 / "AZ License Number: 396575 <br />Manufacturer Training <br />Manufacturer _ Component(s) Date Trainin Ex fres <br />Ronan hydrostatic Precision Test Equipment NA <br />3. SUMMARY OF TEST RESULTS <br />Component <br />Pass Fail <br />Not <br />Tested <br />Repairs <br />Made <br />Component <br />Pass Fail Not Repairs <br />Tested Made <br />Waste Oil Secondary Vent <br />X <br />0 <br />D <br />Main Diesel Tank Annular <br />X <br />Waste Oil Secondary Remote Fill <br />X <br />0 <br />7 <br />- <br />Reserve Diesel Tank Annular <br />X <br />New Oil Tank -Product / Air Sec. <br />X <br />Waste Oil Pipe Sump <br />X <br />New Oil Tank -Antifreeze Sec. <br />X <br />P <br />New Oil Tank Pipe Sump <br />X <br />C, <br />New OiI Tank-Oil/Air Sec. <br />X <br />0a <br />_f <br />Main Diesel Tank Pipe Sump <br />X <br />New Oil Tank Vent Sec. <br />X <br />L) <br />!C <br />D <br />Reserve Diesel Tank Pipe Sump <br />X <br />1 <br />Main Diesel Tank -Product Sec. <br />X <br />[ <br />7 <br />Waste Oil Fill Sump <br />X <br />Main Diesel Tank -Vent Sec. <br />X <br />L <br />D <br />New Oil Tank Fill Sump <br />X <br />Lj <br />Reserve Diesel Tank -Product See. <br />X <br />n <br />L. <br />Main Diesel Tank Fill Sump <br />X <br />rJ` <br />E0 <br />Reserve Diesel Tank -Vent Sec. <br />X <br />0 <br />L <br />Reserve Diesel Tank Fill. Sump <br />X <br />u <br />Transition Sump-Antifreeze/Air Sec. <br />X <br />�j <br />G <br />3 <br />UDC Satellite 2 <br />X <br />C1 <br />-1 Li <br />Transition Sump -Grease Sec. <br />X <br />_? <br />C <br />E <br />UDC Satellite 4 <br />X <br />C. <br />r i= <br />Waste Oil Tank Annular <br />X <br />0 <br />UDC Master Dispenser 1/ 2 <br />X <br />0 <br />L E <br />New Oil Tank Annular <br />X <br />- <br />r� <br />i <br />UDC Master Dispenser 4 <br />X <br />Notes: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />