Laserfiche WebLink
Page 1 of 8 <br />SWRCB, January 2002 <br />Secondary Containment Testing Report Form — FINAL DRAFT <br />Ji.ris, j, tracrodeditir uva by cuntr"clipry perJirrrnJng perlodic tenting of UST setumdury 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 far submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: Norms 76 <br />Facility Address: 633 E. Victor Rd <br />Facility Contact: Greg Wilson <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present dut <br />'t1 <br />Date of Testing: 1 1/ 4 0 2 <br />i CA 95240 <br />Phone: 209-367-1795 <br />10/8/02 <br />CompanyName: Oil Equipment Service <br />Technician Conducting Test: James P. Hesketh <br />Credentials: tXCSLB Licensed Contractor U SWRCR Licensed Tank Tester <br />License Type -A, H a z, C61 , C1 0, C5 7, C 21 License, Number: 323417 <br />Date <br />k <br />Dispenser Pans J <br />7 ai►w,ris,s ♦ ■s J f%iP'1`1PeirV Q111 Mt <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in th document are accurate and in full compliance with legal requirements <br />Technician's Signature: <br />7 Date: 11/4/02 <br />es es <br />