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SWRCR,January 2002 [I .(; : fi <br /> }} Page 1 of 7 <br /> ENVi ,( <br /> Secondary ContainmelfMldport 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 /> California Contractor License 309105 A-C61/D40 HAZ/HIC E-mail ssseco 7pacbell.net <br /> 1. FACILITY INFORMATION <br /> Facility Name: Bank of Stockton I Date of Testing: November 24,2008 <br /> Facility Address: 1941 Lockheed Court,Airport Hanger,Stockton,CA <br /> Facility Contact: Norm White I Phone: 209.483.0257 <br /> Date Local Agency Was Notified of Testing: 11/12/2008 <br /> Name of Local Agency Inspector(if present during testing) Muniappa Naidu <br /> 2. TESTING CONTRACTOR INFORMATION_ <br /> Company Name: Stockton Service Station Equipment Co.,Inc. <br /> Technician Conductin Test: Mike Jones ICC 52525370-U1 <br /> Credentials: [X]CSLB Licensed Contractor [ ] SWRCB Licensed Tank Tester <br /> License Type: C-61/D40 HAZ/HIC License Number: 309105 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> Smith Fiberglass Products Company N/A <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Spill/Overfill Containment Bucket x X <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> FILL ADAPTER WAS LEAKING, REMOVED, CLEANED AND RE-INSTALLED. <br /> RE-TESTED. <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: Mike Jones Date: November 24, 2008 <br />