Laserfiche WebLink
v <br />h5 '� <br />Alitecho�� �r �c <br />.0 <br />t 1 R <br />WL: <br />MAY 2 8 2015 <br />P.O. Box 4208 <br />Sonora CA 95370 <br />Ca: 623541 A-Haz <br />Phone: 209-532-7320 <br />Fax: 209-533-2650 <br />mail@alltechpetro.com <br />www.ailtechpetro.com <br />This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this <br />form to report results for all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be <br />provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: Hammer 1-5 Arco Date of Testing: 05/07/15 <br />Facility Address: 3201 W. Hammer Lane Stockton CA <br />Facility Contact: Wes Parkinson Phone: (209) 474-9125 <br />Date Local Agency Was Notified of Testing : 04/29/15 <br />Name of Local Agency Inspector (if present during testing): Stacy Rivera <br />2. TESTING CONTRACTOR INFORMATION <br />If hydrostatic testing was performed, describe what was done with the water after <br />completion of tests: <br />Testing water stored in barrels 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 Signature: Date: 05/07/15 <br />Master87 • - Sump <br />Vapor Transitie • <br />87 Syphon • • Sump___------- <br />�1 <br />���> <br />• • • • <br />�� <br />0�0� <br />• - Sump�/ <br />91 <br />�00 <br />0�■ <br />■�0■ <br />000 <br />. • • • • - <br />`� <br />�00 <br />// <br />Q <br />■OQ■ <br />Rim■00 <br />87 Master Annular�/ <br />��■�0■ <br />►1 <br />0 <br />■00■87 <br />Syphon Annular87 <br />Product91 <br />/1 <br />0 <br />■00 <br />00■ <br />OOj <br />Product Line <br />If hydrostatic testing was performed, describe what was done with the water after <br />completion of tests: <br />Testing water stored in barrels 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 Signature: Date: 05/07/15 <br />