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• RECEIVED <br /> SWRCB,January 2002 JUL 0 7 ,,Jag, of_ <br /> Secondary Containment Testing Report Form tt��11. n� t�����u <br /> This foL is intended for use by contractors performing periodic testing of UST seconaW�ysT AL GTGd111rt H <br /> appropriate pages of this form to report results for all components tested The completed form,( EfDARr ewres, and <br /> printois from tests(ifapplicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facili y Name: System Transport I Date of Testing: May l2,2014 <br /> Facili y Address: 707 East Roth Road,French Camp,Ca.95231 <br /> Facili y Contact: Sam Abundi I Phone: (209)983-8062 <br /> Date Local Agency Was Notified of Testing: 4/18/2014,by Afford-A-Test <br /> Name of Local Agency Inspector(ifpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: R&D Compliance Testing <br /> Technician Conducting Test: Benjamin F.Duncan Jr. <br /> Credentials: CSLB Licensed Contractor X SWRCB Licensed Tank Tester <br /> Lice'seType: Tank Tester License Number:90-1120/ICC#5246802-UT <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Ex fres <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Ann ilar Tank#1 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Secondary Pipe #1-Master X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Secondary Pipe #2-Satelite X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Secondary Pipe#3-Satelite X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Pipi6g Sump#1 X I ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Dispenser Sump#1&2-Master X I ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Dispenser Sump#1-Satelite X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Dispenser Sump#2-Satelite X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <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,thefacts stated <br /> dii+n'1/this <br /> 7�document are accurate and in full compliance with legal requirements <br /> e,� <br /> Techn cian's Signature: r,Gr Jr Date: May 12,2014 <br />