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Page <br /> Secondary Containment Testing Report Form <br /> ThirJ'orm+isvrcrsdc,3y`crvsehp"cun:rrurarsprrrfvmeasg�c , ,.. >e.�ras�r,''L�57s,-rcr�zriarpczstcan�rr�z;+-s:t:#a Lrse:tr <br /> app r ge$r f.+Zsfom to repo"res h'3',e artd r;.xrWr_ us rextr,j the cam�*trsrd fo e..�aca ecxz r^T+eerieres, <br /> }rr' frCxrx:rztt( etpjeikatu'< :torr frar m Ae lrai rrgulworr cgerxy. <br /> Ct)StCO n 6§8 <br /> 3250 W, Grant;na fid. <br /> ELAy Nwm — Tracy, Ca 95304 <br /> FacifityAddrass: — N06179-88989 Testing .� ._. <br /> Date Local Agency Was Notified or Testing <br /> Noma of Loaaf Agcncy inspector f fpres,tnr dar7rtj resrtrg3: N'4 <br /> 2. TESTING CONTRACTOR tNTOMMON <br /> Cradavda <br /> Li 0 C LH I-xvused ConawtorQS 'FtCB t Tamk Te,uux <br /> License Tgpa: A B ASB Cr10 HAZ M _ Lb"zzac Number-30D345 <br /> kInnufacturcr TrAininn <br /> 3.4arwraenuer _ Czyrn�nc) Data Trainat8 Expires <br /> _ SUPPLIED U bN REQUEST <br /> _ 3. <br /> a Repairs <br /> U1� � �?'i•ra _ _ Stn.nLA_RYtO'Fu <br /> i TQFSrR_ESL'L-fCSI's 120paks <br /> Ccrupoftnt Pas Fad Te <br /> T <br /> Pass MaH Trskd <br /> _ 7 O O C 13 O O <br /> b 0 7 0 O O <br /> D 0 O a Q O <br /> 0 0 0 0 O O <br /> 0 00 0 O O E03 CI <br /> 0 ❑ 0 0 O O Q <br /> 0C3 Q E3 O ❑ O t3 <br /> Q C3 <br /> ❑ Q _m.. O 01 O O <br /> ❑ I ❑ Na0 O f © yQ <br /> ❑ 0 Q i 0 D O O ❑ <br /> ❑ ❑ Q 8 ❑ Q ❑ ❑ O <br /> Q Q 0 ❑ _ O Q D a <br /> O ❑ d ❑ I O ❑ Q O <br /> It hydrostatic testing was pertornnd,dasctiba wbag was dune%*h the water after completion of testa: <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUC TING THIS TEMNG <br /> To the best of my knvwkdge,Ar fmrtx MW <br /> �v in thin darmunr#=r r met in f ff comer}h.,xub drgal re na <br /> Technician's Signature; .�,.i / .s Date: <br />