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r(CVL. l Y %.-v <br /> SWRCB,January 2002 FF" ..i Page__of___ <br /> Secondary Containment Tes .Ag 5 rquft <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the <br /> appropriate pages of this farm to report results for all components tested. The completed form, written test procedures, and <br /> printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Yellow Freight I Date of Testing: 12/15/2010 <br /> Facility Address: 1535 Bast Pescadero Ave.,Tracy,Ca.95304 <br /> Facility Contact: Chris Roy Phone: (209)833-1300 <br /> Date Local Agency Was Notified of Testing: 12/9/2010 ,by Afford-A-Test <br /> Name of Local Agency Inspector(fpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: R&D Compliance Testing <br /> Technician Conducting Test: Benjamin F. Duncan Jr. <br /> Credentials: 0 CSLB Licensed Contractor X SWRCB Licensed Tank Tester <br /> License Type: Tank Tester License Number: 90-1120/ICC#5246802-UT <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Secondary Pipe#1 X ❑ ❑ ❑ ❑ ❑ <br /> Secondary Pipe #2 X ❑ ❑ ❑ ❑ ❑ C_ <br /> Secondary Pipe #3 X ❑ ❑ ❑ ❑ ❑ -_ <br /> Piping Sump#1 X ❑ ❑ ❑ ❑ ❑ <br /> Piping Sump #2 X ❑ ❑ ❑ ❑ <br /> Piping Sump #3 X ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ rE ❑ ❑ - <br /> ❑ ❑ ❑El ❑ ❑ 11 ❑ ❑❑ ❑ EJ ❑ ❑ <br /> ❑ ❑ 1 ❑ ❑ ❑ ❑ D <br /> If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br /> Test Fluid Supplied and recovered for reuse by R&D Compliance Testing. _. <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: Date: December 15.2010 <br /> v <br />