Laserfiche WebLink
SWRCB,January 2002 Page 1. <br /> Second y Containment Testing Repot Form <br /> This form is intended for use by contractors performing periodic 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 test procedures, and <br /> printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: CONOCO PHILLIPS #2705448 DateofTesting: 10/22/2007 <br /> Facility Address: 3202 W HAMMER LANE STOCKTON, CA, 95209 <br /> Facility Contact: MANAGER Phone: (2 0 9) 957-2900 <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: MATTHEW HASLEY <br /> Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type: A I License Number: 743160 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> tanknology all 05/29/2009 <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repair <br /> Component Pass Fail Tested Made Component Pass Fail Tested Made <br /> Tank Annular 1 [2], 1:1 ❑ ❑ UDC 7/8 ❑ El o <br /> Tank Annular 2 x F ❑ ❑ ❑ ❑ ❑ ❑ <br /> Tank Annular 3 1x] ❑ ❑ ❑ ❑ ❑ El ❑ <br /> Secondary Pipe 1 reg E [ ] 1-1 ❑ 1:1 El El <br /> El- <br /> Secondary Pipe 2 sup ❑ ❑ 1:1 1:1 E] <br /> Secondary Pipe 3 dsl F-1 El ❑ ❑ <br /> Piping Sump 1 x <br /> 101 ❑ ❑ M ❑ ❑ <br /> Piping Sump 2 E1 F ] F1 El El El E <br /> Piping Sump 3 El El El El M El El <br /> UDC 1/2 � ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> UDC 3/4 FRI ❑ ❑ ❑ ❑ E ❑ El <br /> UDC 5/6 ❑ ❑ a ❑ ❑ ❑ El <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> site to site <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: Date: 10/22/2007 <br />