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AUG-26-2008 08 :38 AM GETTLER—RYAN INC. 925 551 4770 P. 02 <br /> 1 • • <br /> Secondary Containment Testing Report Form <br /> For 1 ve hr ('gidnce.11c'nlhrr.lttrr,rha'or❑'henup/11w rl/hr rola•/,vc-lit./1(1•i.vdi/1011 <br /> .I flllfnl'IQ'(%/141: I lCJI,(1 PM1(.1Jh l (nr(t' <br /> This form, or the standard form develped by the State Water RCsources Control Board (SWRCB). must be used <br /> by contractors performing periodic testing of underground storage tank (USI') secondary containment systems <br /> in Unidocs member agency,jurisdictions. The completed form. written test procedures.data collection Ings, and <br /> printouts from test equipment (if applicable), must he provided to the fiicility owner/operator t'.)r submittal to <br /> the local regulatory agency within 30 days ot'thC ICst date. <br /> SWRCB requires that the entire volume ot'cach sump and under-dispenser containment (UDC) system he tested <br /> if the sump,UDC is not equipped with a continuous monitoring systum that ,but,,, down the pump when a leak is <br /> detecetd or the leak detection sensor tails or is disconnected. �s,',•s flu,)I,r ;,l iladxne• !.rare Lc.-u,nl <br /> Systems where leak detection equipment continuously monitors both primary and secondary containment (e.g. <br /> systems that are hydrostatically monitored ur Under constant \ac'uum) are exempt from periodic testing <br /> requirements. I->)rc•R a2n\;„nu,ll <br /> In the case of pressure/vacuum testing. upy loss in pressurC.cacuum during the course of the test shall be <br /> considered a tailed test, regardless of the manutaCturor'S er(1criU fix declaring a pusSW test. 12.1 c(AR 41637111 2)I <br /> A. Facility Information <br /> [Ta7iTfly Name: PG&E I DalyI,1' I'rvling; . August 19, 200NSite Address: 4(140 West Ln., Stockton Ca <br /> F <br /> acility Contact: Michelle Le <br /> tate Local Agency was Notified of I'estutu : ---.._.-....—.— <br /> Name of Local .Agency Insric n t,01 preNem f1twim,,h"1111,r <br /> B. Testing Contractor Information <br /> Company Name: Gettler-Ryan Inc. <br /> Credentials: ❑ CSIA-L.ieensed Cmiln mvr: l_..1 \\'Itc n-Licensed lank li'sler <br /> License r�•pr: ❑ A; [�C-111: ❑ C.:�'l; ❑ t lees „] ('-nl 1)40) 1 icensc NwWwr <br /> Name orTochnician Conduclinv Tcsl.: . . .._..... .._.._.... ....-- <br /> ------- - <br /> Training by F.ttuipment Nlanufacturer. <br /> i Ilatc'I'raim:na N:x leen <br /> �lannh)cplrer ('om)onrallsl <br /> Ii <br /> C. Certification by Technician Responsible for C'un(IuctIng , esting <br /> To the hest of m�' knowledge, the facts stated in this document are accurate and in full compliance with <br /> legal requirements. <br /> frrlmician's SianahlYe: Vale; <br /> e,ay.tl1111111r1.1O'4 (12:26.11: <br />