Laserfiche WebLink
` SWRCB..lanuars 7002 Page 1. <br /> Secondary Containment Testing Report Form <br /> T his loan is intetidc�c�Jnr use by contractors per�i,�rtnit�g periodic testing t!1 L'ST sc caldury corutihuuerrt srstenrs. 1'se the <br /> appropriate pages of this forin to report resultsfor till components[este d The connpleted fotvn, a riueri testprocedures, aid <br /> prinlouts,Ji-om tests tiJ'applicahlel. should he provided to the JiicilitV owner operator for submittal to the local regularory 11 CI car. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO #06080, CC 18022649 Datc ofTcstinL: 10/09/2006 <br /> Facility Address: 85 E LOUISE AVE PTO N-71, LATHROP, CA, 95330 <br /> I-acilityContact: MANGER Phone: (204) 983-9144 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: JOEY MESA <br /> Credentials: CSLB Licensed Contractor SWRCB Licensed Tank"fester <br /> License Type: I License Number: <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Lspires <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repair <br /> Component Pass Fail Tested Made Component Pass Fail Tested <br /> Made <br /> Spill Box 1-REG 1-87 El ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Spill Box 2-PLUS 2-89 ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Spill Box 3-PREM 3-91 1:111:1 <br /> ❑ ❑ 1:1 El ❑ ❑ <br /> El El El El El 1:1 El El <br /> 0 El El El El El <br /> El- <br /> El El El El El El 1:1 El <br /> El El El El El El El El <br /> El El El El El El El El <br /> E El El El El El El <br /> El El El El El El El <br /> El El El El D D Ll <br /> I f 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 best of tnv knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: 4;�l n` Date: 10/09/2006 <br /> 6� <br />