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SWRC9,January 2002 Page ) of <br /> Secondary Containment Testing Report Form <br /> fn's form is)ntendedPr use by contraclorsperfbrmingperiodic testing of UST secondary containment systems. Use the <br /> appropriate pages of this form to report results for all components tested. The completed form, written testproeeatrres,and <br /> printo bftom tests ffapplicable),should be provided to the jb6hty ower/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION SS#: 6080 <br /> Facility Name: BP West Coast Products,LLC I Date of Testing: <br /> Facility Address: 85 E LOUISE AVENUE City: LATHROP Zip: 95330 <br /> Facility Contact: p �. Phon _ <br /> Date Local Agency Was Notified of Testing: 1/6 5 <br /> Name of Local Agency Inspector(ifpresentduring testirag): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SYSTEMS <br /> T e ctunclan Conducting Test: e. <br /> Credentials: JLCSLB Licensed Contractor SWRCB Lic ens e d T ank T e ster <br /> License Type: A ASB HAZE Ci0 License Number. 588098 <br /> �'_,-fActarer 3kalift <br /> Manufacturer Component(s) Date Trainia Expires <br /> 3. SUAGVIARY OF TEST RESULTS <br /> Component Pa:s Fail Not R%mirs <br /> Te ied Made Component Pass Fail Tested Made <br /> 0 0 0 ❑ 0 0 ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> rtq ❑ A <br /> jf 0 0 ❑ 0 ❑ ❑ <br /> $� ❑ 0 0 ❑ ❑ 0 0 <br /> 0 0 0 ❑ ❑ 0 0 <br /> ❑ ❑ ❑ 0 ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ 0 D <br /> 0 ❑ 0 0 0 ❑ 0 0 <br /> 0 0 0 ❑ 0 ❑ ❑ 0 <br /> ❑ 0 ❑ 0 ❑ ❑ ❑ 0 <br /> ❑ ❑ ❑ 0 0 ❑ 0 ❑ <br /> 0 0 0 0 0 ❑ 0 G <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 best of my knowledge,the facirstated in this document are acea ate and in f dl compliance with legal regadrexmaxis <br /> Date: <br /> Technician's Signat <br />