Laserfiche WebLink
RJQEIVED <br /> JUL 31 2015 <br /> SWRCB,January 2W2 Pwof <br /> FNVIRO E HEALTH <br /> Secondary Containment Testing Re ICES <br /> This form is intended for use by comractors performing periodic testing of UST secoadwy coniabuuent systems Use the <br /> appropriate ids ofdtisform to for all congvrwnts tested The co"94efed fom wrtan AestProcedum,and <br /> printouts from tests(if applkabk),a%sdd be provickd to the facility ownerloperator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> FvAi4tyNamc ARP Mini Mart 76 jDmeofTestbW. June 23,201 5 <br /> Facility Address: 25775 So.Patterson,Tracy,CA.95376 <br /> Facility Contact: Neil Patel Phone: 209-835-7777 <br /> Babe Local Agency W ds Notified of Testing: June 0 6, 2 01 5 <br /> Name of Local Agency bvector(f'p : <br /> 2. TESTING CONTRACTOR INFORMA'T'ION <br /> Com Name: Reliable Petroleum Services Inc <br /> Technician Conducting Test Ernesto Bernabe <br /> Credentials: 91 CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester <br /> License Type. , A I License Number 883706 <br /> Manufaett= C nen s Date irea <br /> INCON TS—STS August 06,2015 <br /> ICC Service Tech August 10,2015 <br /> 3. SUMMARY OF TEST RESULTS <br /> Not � i�ivt ro <br /> Componew Pas Fall Tested . Mjtde ComPor<ent Paas Fall Tested Made <br /> Annular 87 Syphon © 0 ❑ STP Sum 91 ® ❑ ❑ ❑ <br /> Annular 87 Master. ® ❑ 11 UDC 1 /2 P El 0 <br /> Annular 87 Slave ® ❑ ❑ ❑ UDC 3/4 ® C3 11 <br /> Annular 91 19 ❑ ❑ 0 UDC 5/6 N ❑ ❑ 0 <br /> Secondary 87 Syphon E ❑ PD -0❑ UDC 7/8 0 0 ❑ 0 <br /> Secondary 87 Master ❑ Fill Sump 87 Syphon 0 ❑ ❑ ❑ <br /> Secondary 87 Slave 11 pFill Sump 87 Master ❑ ❑ Ci <br /> Secondary 91 ® ❑ Fill Sump $7 Slave N ❑ ❑ ❑ <br /> STP Sump 87Mast/Syph ® ❑ Fill Sump 91 0 ❑ ❑ ❑ <br /> STP Sump 87 Syphon 0 ❑ ❑ ❑ <br /> STP Sump 87 Master N ❑ ❑ ❑ ❑ ❑ <br /> STP Sump 87 Slave l9 ❑ ❑ ❑ ❑ ❑ <br /> If hydrostatic tostin$was p cCrlbe what was done will►the water after etxnP of test <br /> CERlYFT7CAOF7CAN RE5PON5iBI.E FOR <br /> To tie best of my tls dec umew=_T: Date: June 23,2015 <br />