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SWRCR, January 2002 Page I of 7 <br />Secondary Containment Testing Report Form <br />Stockton Service Statibn 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 -C6 I /D40 HAZ/HIC E-mail s§ggg@bp#Sb2ll-net <br />I FacilityName: sT(,-o Gan Sere; ce I Date ot-Testing: 3 — 8 — 2 0 0 5 <br />—Facility Address: <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing: 3-6-2005 <br />Name of Local Agency Inspector (if present during testing) <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: Stockton Service Station Equipment Co., Inc. <br />Technician Conducting Test: <br />`Credentials: . IX I CSLB Licensed Contractor SWRCB Licensed Tank Tester <br />License Tvr)e: C -61/D40 HAZ/HIC License Number: 309105 <br />Manufacturer Trainins! <br />Manufacturer Component(s). Date Training Ex2ires <br />Smith Fiberglass Products <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CER T'FICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are, <br />Technician's Signature: <br />and in full compliance with legal requirements. <br />Date: 3-8-2005 <br />