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TS7393-05 Page_L of 2_ <br /> • <br /> Secondary Containment Testing Report orm <br /> 'Phis form is intended for use by contractors performing periodic testing of'USr secondary containment systems. Use the <br /> appropriate pages of this form to report results far all components tested. The completed form,written test procedures, and <br /> printouts froth tests(if applicable), should be provided to the faciiity owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: SHELL OIL PRODUCTS—STOCKTON TERMINAL I Date of Testing: T1/13/06 <br /> Facility Address: 35 t5 NAVY DRIVE, STOCKTON,CA. <br /> Facility Contact: GERALD LANG Phone: 209 46fi�i941 <br /> Date Local Agency Was Notified of Testing: 48 HOURS PRIOR(MIN.) <br /> Name of Local Agency inspector(if present during testing): Raymon Von Flue <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SYSTEMS <br /> Technician Conducting Test: MICHAEL L. STRAWN II <br /> Credentials: ® CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Type: A B ASB C-IO HAZ License Number: 588098 <br /> Manufitchtrer 1'ruinina <br /> Manufacturer Com neat s) Date Training Expires <br /> SUPPLIED UPON REQUEST <br /> 3. SUMMARY OF TEST RESULTS <br /> Not RepairsNot Repairs <br /> Component Pass Fail Tested Made Component Pass Fail Tested Made <br /> TANK ANNULAR(RECLAIM) <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 bead of my knoWedge,the facts stated in this documeid are accurate and in full compliance with legal requirements <br /> Technician's Signature%"A� Date:....11/13/06 --— <br /> cool$) 'IVJ.NHIINOHIMIH IIVZ TTOTSSS9T6 XVd SV:LT 900Z/6T/TT <br />