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t 9 <br /> RECEIVED <br /> Secondary Containment Testing Report Form APR 06 2015 <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment syste sg thea _ <br /> appropriate pages of this form to report results for all components tested. The completed form,written test proFs&qur� d4,W lTAL <br /> printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local reguill"t - N <br /> 1. FACILITY INFORMATION <br /> Facility Name: Unocal 255886 Date of Testing:03/06/18 <br /> Facility Address: 2701 West March Lane,Stockton CA 95219 <br /> Facility Contact: I Phone (209)473-7337 ❑Initial ❑Repair Test <br /> Date Local Agency Was Notified of Testing: 02/28/18 p 6 Month ❑Other <br /> Name of Local Agency Inspector(if present during testing): No Inspector on Site ❑Triennial <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: ABLE Maintenance,Inc. <br /> Technician Conducting Test: Eric Salinger/I.C.C.#8729425 <br /> Credentials: 2 CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester ✓❑ICC UST Service Technician <br /> License Type: A,B,HAZ.,C10 License Number:3128" <br /> Manufacturer Training <br /> NMEW <br /> Manufacturer Com onent s Date Trainin Ex ires <br /> Available upon request <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> 91 Secondary Product ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> UDC 11/12 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Used Pump Test Truck <br /> For any equipment capable of generating a print out of test results,you must attach a copy <br /> of the test report to this certification ❑ System printout attached. <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: 03/06/18 <br />