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-S WRCB,January 2002 Page I of I <br /> Secondary Containment Testing Report Form <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate <br /> pages of this form to report results for all components tested. The completed form, written test procedures,and printouts from tests(if <br /> applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> FacilityName:YRC 813 Date of Testing: 11/25/2013 <br /> Facility Address: 1535 E PESCADERO AVE ,TRACY,CA 95304 <br /> Facility Contact:KRIS/ROY Phone:209-993-7946 <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(if present during testing):not present <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name:TANKNOLOGY INC. <br /> Technician Conducting Test:Jarrod Cooke <br /> Credentials: r CSLB Licensed Contractor 1.. S WRCB Licensed Tank Tester <br /> License Type:a ILicense Number:743160 <br /> Manufacturer Trainine <br /> Manufacturer Component(s) Date Training Expires <br /> tanknology all 5/162014 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Not Repairs <br /> Tested Made Component Pass Fail <br /> Tested Made <br /> Secondary Pipe Test(Tank waste oil near nuk- X <br /> ..to oil <br /> STP Containment for Tmik waste it near nck X <br /> waste oil- <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> taken/recycled water trailer <br /> CERTIFICATION OF TF,CIINICIAN 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 /> Technician's Signature: � Date: 11252013 <br /> WO:2315605 <br />