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S WRCR, January 2002 Page I of 7 <br />SecondaryContaimuent Testing Report 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 gsgW&& bes ll.net <br />7 r, a l+iT iTv 7ATTi'ni? M ®TinW <br />Facilitv Name VG Date of Testin : _ _ <br />Facility Address: <br />Facility Contact: Bob Caw 1 Phone: <br />Date Local A ency Was Notified of Testing: _ _ <br />Name of Local Aaency Inspector if 2resent during testing) <br />Company Name: Stockton Service Station Equipment Co., Inc. <br />Technician Conducting Test: --- <br />Credentials: [X ) CSLB Licensed Contractor [ ] SWRCB Licensed Tank Tester <br />License Type: C -61/D40 HAZ/HIC License Number: 309105 <br />Manufacturer IMining <br />Manufacturer Components) Date <br />Smith Fiberglass Products Company FRPP�inq MG <br />rt rnRrT A nv nr� T�eT uT_criT .TC <br />Component Component <br />If hydrostatic testing was periormea, aescrioe wna` was uunc wuu tuc -u%-a A.". -un-ra..••..• — •....,w. <br />CERT IFICATT N OF TECHNICJAN 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: May 2. 2005 <br />