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t <br /> Page I of I <br /> Secondary Containment Testing Report Form <br /> Stockton Service Station Equipment Co., Inc. <br /> 808 N.Union Street,$tockton,CA 95205(209)461$333 Fax(209)46448349 California License 309105,A C-61/D40 HAZ <br /> E-MAIL swot ac;Wl.r et www.stwkton3crvic4statiQn.co <br /> 1. FACILITY INFORMATION _ <br /> Facility Narne:FAST&EASY CHEVRON i Date of Testing: January17,21x15 <br /> Facility Address:Hwy 99 and Eight Mlle Road,Stockton,CA 95212 <br /> Facility Contact: Pushha I Phone: 1-707-747-2955 <br /> Date Local Agency Was Notified of Testing; <br /> Name of Local Agency Inspactor(iifpreseraf daring testing): <br /> 2. TESTING CONTRACTOR INFORMATION _ <br /> Company Name: Stockton Service Station Equipment Co.,Ina _ <br /> Technician Conducting Test: Eric Motgaard and Mite Jones <br /> Credentials: [X] CSLB Licensed Contractor [ ] SWRCB Licensed tank Tester <br /> License Type: C-61ID40 HAZ441C License Number: 309105 <br /> Manufacturer Trainin¢ <br /> Manufacturer Component(s) Date Trainer Expires <br /> Western Fiberglass Inc. Piping/Sump Systems NiA <br /> 3.SUMMARY OF TEST RESULTS <br /> • Compowat Pus Fall Not Repairs I Component Pass Fall Not Repairs <br /> Tested Made Tated Made <br /> 89 Octane,Split Bucket X % <br /> U hydrostatic testing was performed,dcxnTe what was done with tae water tiller completion of tau: <br /> PAGES 2, 3,4, 5, 6,are not applicable. <br /> NOTE: REPLACED DRAIN VALVE AND TESTED. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTION THIS 7ESTTNC <br /> To the best of my knowledge.the&cn stated in this down m are actuate end in full compliance with]CO requirements. <br /> Technician's Signature: 'Eric 'Mnrgan-rdand'Mike TmeS _Date: January 17,2005 <br /> Eric Molpard and Mike Jones <br /> Original mailed to: San Joaquin County Envirommental Health Division <br /> • <br /> T 'd 002E L3f'N3SU_l dH W865; : 11 2002 02 kiUC <br />