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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 />Facility Name: SHELL # 136186 <br />Date of Testing: 03/14/2007 <br />Facility Address: 3725 TRACY BLVD , TRACY, CA, 95376 <br />Facility Contact: MANAGER <br />Phone: (2 0 9) 835-7608 <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 />M� <br />Technician Conducting Test: <br />ROBERT SANTOS <br />Credentials: <br />CSLB Licensed Contractor <br />0000' <br />SWRCB Licensed Tank Tester <br />License Type: <br />Manufacturer <br />I License Number: <br />Manufacturer Training <br />Component(s) <br />Date Training Expires <br />Spill Box 2 PLU FILL <br />Spill Box 3 PRE FILL <br />dlu' 1 `1� it l*41 Htll`I�.`! <br />011111011411 <br />M� <br />011111411141t <br />Box I REG FILL <br />0000' <br />��00 <br />Spill Box 2 PLU FILL <br />Spill Box 3 PRE FILL <br />Spill Box , DIE FILL <br />DDO�i■ <br />��00'! <br />0000 <br />a000 <br />■■0000 <br />■�0000 <br />0000 <br />■��0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />0000 <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <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: 03/14/2007 <br />