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UC 1194 Page_1 of_2_ <br /> Secondary Containment Testing Report 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 /> 1. FACILITY INFORMATION <br /> Facility Name: CONOCO PHMLIPS SS#2611194 Date of Testing: 6/9/06 <br /> Facility Address: 2375 TRACY BLVD TRACY,CA. <br /> Facility Contact: LINH HUYNH Phone: 209-835-7755 <br /> Date Local Agency Was Notified of Testing: 48 HRS PRIOR N [NNIMUM <br /> Name of Local Agency Inspector(if present during testing): WILLY NG <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL SYSTEMS <br /> Technician Conducting Test: DAN LUCK <br /> Credentials: ® CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Type: A B ASB C-10 HAZ License Number: 588098 <br /> Manufacturer Trainine <br /> Manufacturer Components) Date Training Expires <br /> SUPPLIED UPON REQUEST <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repairs <br /> Component Pass Fail Tested Made Component Pass Fail Tested Made <br /> 100 TURBINE SUMP ® ❑ _ ❑ <br /> ❑ ❑ <br /> ❑ 0 ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ <br /> ❑ ❑ ❑ ❑ <br /> 11 ❑ 0 ❑ 11 ❑ 0 ❑ <br /> ❑ ❑ <br /> ❑ 11 ❑ <br /> ❑ 0 ❑ 0 ❑ <br /> 709 , 0 1 ❑ ❑ 10 <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> ALL TEST WATER WAS CONTAINED IN 2 EXISTING 55-GALLON DRUMS ON SITE. <br /> CERTIFICATION OF TE CLAN RESPONSIBLE FOR CONDUCTING THS TESTING <br /> To the best of my knowledge,the fads stated in this document are accurate and in full compliance with legal requirements <br /> Technician's Signatur Date:_6/9/06 <br />