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� � RECEIVED <br />MAY 0 5 2013 <br />Secondary CoFoSMJOAQUIN ntainment Testing Report ter EWRO-NM -ECOUNTY <br />This form is intended for use by contractors performing periodic testing of LIST secondary containment #M§WJNW&4VM7NT <br />appropriate pages of thisform to report results for all components tested The completedform, written test procedures, and <br />printouts from tests (if applicable), should beprovided to thefacifily ownerloperatorfor submittal to the local regulatory agency. <br />0 <br />WWWW"I 4101,11j) �14 N <br />w"*"' �-V =aft of Le!�R: 70W <br />Facility Name: -N <br />Facility <br />FacilityAddress-Z�i[V)- *erT1**^PA-J k-� L -=C=7 4:::� <br />r <br />-"*ty <br />acility Contact Phone: <br />Facility <br />F F <br />Date Local Agency Was Notified of Testing: SB999 - <br />N) <br />Name <br />Naf Local Agency Inspector ffpresent during testing); <br />0 r. r, 07-M <br />I Technician Conducting Test: Asa Heintz I.C.C. # 5252032-Ul I <br />I Credentials: 0 CSLB Licensed Contractor 0 SWRC]B Licensed Tank Testa <br />[—License Type: A. B, JIM, CIO I License Ntanber. 312844 <br />Date <br />� M <br />... . .. .. .. .. <br />11 F,' <br />Turbine Sump - <br />Spill Ducket - <br />A <br />1. <br />If hydrostatic testing was performed, describe what was done with the water after completion oftests: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, thefactsslakd In: this document are and Infull compliance with kgal requirements <br />Technician's Signature:_�— Date: <br />......... W <br />