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4 <br />` SWRCB, January 2002 Page T .of Z. <br />Secondary Containment Testing Report Form <br />nis form is intended,for use by contractors performingperiodie testinggf UST secondary containment systems. Use the <br />appropriatepnges ofthis form to report results for all components tested. The completed form, written testprocedves, and <br />printouts,from tests (If applicable), should be provided to the facility owner/cperator for submittal to the local regulatory agancy. <br />1. FACILITY INFORMATION <br />SS#: 21a6 <br />Facility Name: BP West Coast Products, LLC <br />I Date of Testing: to — I Z _v <br />Facility Address: 3212 N CALIFORNIA City: <br />STOCKTON Zip: 95204 <br />Facility Contact: A,, ;cLe-44ev 777FPhone: <br />5 0 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (ifpresentduring testirg): <br />2. TESTING CONTRACTOR INFORMATION <br />Compare Name: TAIT ENVIRONMENTAL SYSTEMS <br />Technician Conductn Test: <br />Credentials: 4SLB Licensed Contractor OSWRCB Licensed Tank Tester <br />License Type: A ASB HAZB C10 <br />License Number: 588098 <br />Manufacturer Training <br />Manufacturer Component(s) Date Training Expires <br />3. SUMMARY OF TEST RESULTS <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the bast of trey knowledge, t7ka factrstated in tilos document are accurate and in fall Compliance with legal raze rements <br />Technician's SignalDate:, — l O <br />�- <br />r�n�■■a <br />o0 <br />o0o <br />a000 <br />o©oo� <br />000� <br />r-�oo■0 <br />nr�oo <br />oaoo <br />r�rado <br />®n©© <br />amino <br />000■� <br />©goo <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the bast of trey knowledge, t7ka factrstated in tilos document are accurate and in fall Compliance with legal raze rements <br />Technician's SignalDate:, — l O <br />