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UCI 194 0 0 Page_1 of_3_ <br /> SecoContainment Testing Report Form <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Ilse 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 ownerloperatorfor submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: CONOCO PHILLIPS SS#2611194 Date of Testing: 5/19/06 <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: 4811RS PRIOR AGNNR" <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: 0 CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester <br /> License Type: A B ASB C-10 HAZ License Number: 588098 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> SUPPLIED UPON REQUEST <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs I Component Pass Fail Not Repairs Tested Made Tested Made <br /> 87 SECONDARY PIPING 0 0 0 0 0 0 0 0 <br /> 91 SECONDARY PIPING 0 0 0 0 0 0 0 0 <br /> 100 SECONDARY PIPING 0 =—0 1:1 0 0 <br /> (FORMERLY 89) 1 1 <br /> UDC 3/4 0 0 0 0 0 0 10 0 <br /> UDC 5/6 1z 10 0 0 0 0 0 0 <br /> UDC 7/8 0 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 0 <br /> 0 0 0 1 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 0 <br /> 0 0 0 0 0 0 0 0 <br /> 1=1=1 0—0 1 1 0 0 0 0 <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> 2 55-GALLON PROPERLY LABELED DRUMS WERE LEFT ONSITE. <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 Signa tuM000--I'l-L Date:-5/19/06 <br />