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SWRCR,January 2002 0 <br /> P090 I of 7 <br /> Secondary Containment Testing Report Form <br /> Stockton. Service Station Equipment Co., Inc. <br /> 808 N. Union Street, Stockton, CA 95205-4152 (209)464-8333 FAX(209) 464-8349 <br /> Cal ifomia Contmctar Limnse 309 105 A-C6 I/D40 HAV14TC E-mail psscco katk <br /> ke I_1.n et <br /> Facility I itY - I. FACILITY INFORMATTON <br /> .Name: Bank of Stockton 11 - ate of Testing: July 12 2009 <br /> racit/_Addes:�1941 E.Lockheed Court,Stockton,CA —1 <br /> FgcilitY Contact; Nom White I Phone: 209.493.0257 - <br /> Date Local Ag2ncy Was Notified of Testing: May 282 2669- <br /> Name ofLt)calAgenc yJbs2ector(ifpresent durin2testiii.&) MuniappaNaidu <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Compaq Naive: Stockton Service Station Equijgment Co.,Inc. <br /> TechniciAn Conducting Test: Rand v Chadwick <br /> Credentialk: IX ISSLB Licensed Contractor r I SWRCB Licensed Tank Tester <br /> Liceiise 7)ipe: C-61/D40 HAZ-AfIC License Number: 309105 <br /> Manufacturer TriL06fig <br /> Manufacturer Component s Date Training Expires <br /> -1 SUMMARY OF TEST RESULTS <br /> cotdoolient Pass Fail Not .Repairs Component Pass Tail Not Repairs <br /> Tested Made Tcstcd Made <br /> Seconds pipt Testing x x <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests. <br /> REPLACED FUX BOOT ON SECONDARY VENT PIPING <br /> cc,iRtir.tcATjoN OF TECHNICIAN RESPONSIBLE FOR cowwriNG THIS TESTING <br /> To the best of my knowledge,the fads state&in this document are acctirate and in null compliance with legal requirements. <br /> Technician's Signature: Agnc( <br /> Chadwick Date: July 1,2009 <br />