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LJCSB04N — SS#2705448 Page 1 of 7 Secondary Containment Testing Reportsyste s This form is intended for use by contractors performing periodic testing of UST secondary containment . appropriate pages of this form to report results for all components tested. The completed form, wr e p o educes, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the c 404toryagency. 1. FACILITY INFORMATION ENVIRONMENT HEai Tu Facility Name: CONOCO PHILLIPS #2705448 1 Date of Test ERViv /04 Facility Address: 3102 WEST HAMMER LANE STOCKTON, CA Facility Contact: MANAGER I Phone: 209-957-2900 Date Local Agency Was Notified of Testing: 10/13/04 Name of Local Agency Inspector (f present during testing): 2. TESTING CONTRACTOR INFORMATION k�wmwif-atwn911IOL-18aw-lI1MK`l If hydrostatic testing was performed, describe what was done with the water after completion of tests: ALL SB989 TEST WATER USED WAS RE -CONTAINED IN STORAGE CONTAINER LOCATED IN TRAILER OF TEST RIG. NO WATER WAS LEFT ON SITE CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: 10/21/04 m m� MM� Repairs , . DIESEL ANNULAR 87 SECONDARY PIPING DIESEL FILL SUMP 91 SECONDARY PIPING 87 SPILL BUCKET ,DIESEL SECONDARY PIPING 91 SPILL BUCKET 87 TURBINE SUMP DIESEL SPILL BUCKET 91 TURBINE SUMPS DIESEL TURBINE SUMPS►� �� �� If hydrostatic testing was performed, describe what was done with the water after completion of tests: ALL SB989 TEST WATER USED WAS RE -CONTAINED IN STORAGE CONTAINER LOCATED IN TRAILER OF TEST RIG. NO WATER WAS LEFT ON SITE CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: 10/21/04