Laserfiche WebLink
Har 02 09 07:22a JP Peoleum Service 9163721B73 p.2 <br />49 <br />SWRCB, January 2002 <br />Page of <br />Secondary Containment Testing Report 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 />I Iva IZI' R VMVE&M <br />Facility Name: <br />Lower Sacramento Chevron TBate of Testing: 12123/08 <br />Facility Address: <br />8660 Lower Sacramento Road, Stockton Ca 95210 <br />Facility Contact: <br />Kamal Kapoor Phone: 209-477-2844 <br />Date Local Agency <br />Was Notified of Testing : <br />Name of Local Agency Inspector (fpresent during testing): <br />3. SUMMARY OF TEST RESULTS <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water was filtered and returned to holding tank. <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 SiDate: <br />alibi" <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water was filtered and returned to holding tank. <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 SiDate: <br />