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SWRCR,January 2002 <br /> Page 1 of 7 <br /> Secondary Containment Testing RepoF rm <br /> q'FJUN -2 pM 2: 00 <br /> Stockton Service Station Equipment Co.,JAW.ro. ,.. <br /> rri`aH� c-;c.°arr <br /> 808 N. Union Street, Stockton, CA 95205-4152 (209)464-8333" �7envF� pg ' r 9 <br /> California Contractor License 309105 A-C61/D40 HAZIHIC E-mail ssseco n pacbell.net <br /> 1. FACILITY INFORMATION <br /> Facili Name: COUNTRY MARKETPLACE Date of Testing: MAY 24,2005 <br /> FacilityAddress: 1789 W.CHARTER WAY, STOCKTON,CA 95206 <br /> FacilityContact: Stephanie LooneyPhone: 209.933.1789 <br /> Date Local Agency Was Notified of Testing: 5.18.05 <br /> Name of Local Agency Inspector(if resent duringtesting) <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Stockton Service Station Equipment Co.,Inc. <br /> Technician ConductingTest: <br /> Credentials: [X CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type: C-61/D40 HAZ/HIC License Number: 309105 <br /> Manufacturer Trainine <br /> Manufacturer Component(s) Date TrainingExpires <br /> Smith Fiberglass Products Company N/A <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Spill/Overfill Containment Boxes X <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <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 /> Technician's Signature: Mike Jones Date: May 24, 2005 <br />