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9255517888 Line 1 14:13:35 12-12-2013 2/7 <br /> a GfTTLfR-RYAN INC. • *'RECEDIVED <br /> SWRCB,January 2002 RG■V•Page l of 5 <br /> DEC 12 2013 <br /> Secondary Containment Testing Report FormICC11AA'�``,,��pp//�������A�♦� I1t <br /> This form is intended for use by contractors performing periodic testing of UST secondary cont4a6111NIBtONMENTAL <br /> appropriate pages of ibis form to report results for all components tested. The complete form, wriMEAW-W�' <br /> printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency, <br /> 1.FACILITY INFORMATION <br /> Facility Name: PG&E Stockton Service Center Date of Testing: 12/4/2013 <br /> Facili Address: 4040 West Lane.,Stockton,CA <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: 11/19/2013 <br /> Name of Local Agency Inspector(ifpresent during testing): <br /> 2.TESTING CONTRACTOR INFORMATION <br /> Company Name: Gettler-R an Inc. 6747 Sierra Court Suite J,Dublin,Ca.94568 Ph.#925-551-7555 <br /> Technician Conducting Test: Elodio Sanchez <br /> redeatials: CSLB Licensed Contractor <br /> License e: C57 B C61/13140 HA2 A C10 License Number. 220793 <br /> illanufacturer Trainine <br /> Manufacturer Component(s) Date Training Expires <br /> Incon Test System Operation Hydrostatic Testing 6/25/2014 <br /> Phil-Tite Spill Containment 7/30/2015 <br /> Opw Spill Containment 516/2015 <br /> ICC Technician UST Components 911312013 <br /> 3.SUMMARY OF TEST RESULTS <br /> Components Pass Fail Not Repairs Components Pass Fall Not Repairs <br /> Tested Made 'Jested Made <br /> 87 Ann X W.Oil Ann X <br /> Diesel Ann X W.Oil Vent Line X <br /> W.011 Product Line X <br /> 87 STP X W.Oil Sump X <br /> Diesel STP X <br /> 87 Product Line X <br /> Diesel Product Line X <br /> Disp 1 X <br /> Disp 2 X <br /> Diesel Disp X <br /> If hydrostatic testing was performed,describe what was time with the water after completion of tests: <br /> Site provided 3 drums <br /> ✓r <br /> CERTFICATION 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 /> Technicians Signature: ��"� '�'�-�� • Date: 12/4/2013 <br />