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From: Franzen -Hill Inc. To: 12094683433 Page: 213 Date: 2/13/2015 3:45:56 PM <br />SWRCB, January 2002 <br />Secondary Containment Testing Report Form FEB 1' 3 20P5, <br />This form is intendedfor use by contractors petforming periodic testing of UST secondary containment I st , <br />appropriate pages of this form to report results for cill components tested The completedform, "PRA4*1MEAT <br />printouts from tests (if applicable), should be provided to the facility ownerloperatorfor submittal to the, tocal7woryVgMcy. <br />1. FACILITY INFORMATION <br />Facility Name: f2SC <br />t4® Date of Testing; S—z4c, t:& <br />Facility Ad C - k V7 ^ <br />dress: I t�vj-j AIRIM(Te MC.Akt*111� CIA M <br />Facility Q A Phone: C %"(,, <br />j <br />Manufacturer Trainiaa <br />3. SUMMARY OF TEST RESULTS <br />it <br />min <br />mom <br />MM <br />0 <br />MM <br />MW <br />----- --------------- ----- <br />If hydrostatic testing was perfortned, describe what was done with the water after completion of tests: <br />1W MU I EC-Me <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in Ilds docuinent are accurate and in fall conipliance wish legal requirements <br />Technician's Signature: Date: � s <br />This fax was sent with GFI FAXmaker fax server. For more information, visit: http:llwww.gfi.com <br />