Laserfiche WebLink
S WkCK January 20 2 <br /> Pa-e <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 PAX (209) 464.8349 <br /> California Contractor License 309105 A-C61ID40 HAZ/h{iC E-mail sssoeuX(D acbcf_ l.nt <br /> •r <br /> 1. FACILITY INFORMATION <br /> Facility Na,ne; VV L Date ofTestin " <br /> Facility d ress:_ <br /> rFacility Contact: - 4� -M�y f,SpA_ - - Phone: <br /> Datc local Agency Was Notified of't'esting: -- - <br /> I Name of Local Agency inspector(if present Burin testuig� "' •— <br /> Z. TESTING CONTRACTOR INFORMATION <br /> Company Name; Stockton Service Station Technician Conducting Test: <br /> Crcdentiafs: IN I CSLB Licensed Contractor [ ] SWR Licensed Tank Tester <br /> License 'Igoe C-61/D40 HAZ/HXC License Number Licensed <br /> 30�T <br /> j 05 <br /> Manufacturer Trainine -- <br /> Manufacturer Component(! Date Tr6ining Expires <br /> Smith Fiberglass Products Corn an NSA <br /> 3. SUMMARY OF TEST RESULTS <br /> Cotnponent PRss FRii Nor Repairs Component Pass Fan <br /> Ttyttd Made 'N'JI <br /> Tested <br /> i <br /> �Il b}-drostatic testing was performed,describe what was done with tate water after corn [etion of tests: <br /> CERTIFICATION OF TECHNICIAN RESPONSIULE.POR CONDUCTING THIS TF.S''INC <br /> I*o Bre best of my knowledge, the facts stated in this do ment are accurate and in full compliance with legal requiremerrts <br /> Tecluliciwi's Signature; bate: <br />