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APR-30-2010 FRI 05: 25 PM P, 006 <br /> r,PIC <br /> Page 1 ot:14 #W <br /> ndary Containment Testing Report Form <br /> This fo m is amended for use by contractors porbmkg perkxfic testing of USTsecord&y cor0arnent systems Use the appropriale paps of <br /> this farm to report results for all components felled. The completed kum,wiffen test procedures,and printouts from tests(if appf ),should <br /> be pmWed to the laaiW for submW to the Icesl regulatory aWcy, <br /> 1. FACILITY INFORMATION F '' Name: Tra Truck StagDate of TeA : 1/16/2009 <br /> FadlityAddress: 3940 N. Tracy Blvd. Tracy, CA 95304 <br /> Facility Contact Debbie Phone: 209-832-5006 <br /> Date Local AgenSLtss Notified of Testing: 03/14/2009 <br /> Nam of Local Agency I ('fit present dudag ): N/A <br /> 2. TESTING CONTRACTOR INFORMATION <br /> CoMMy Nam. EPIC Compliance Systems <br /> TeMnician Conducting Test: Keith Huston <br /> Creden' 0 CSLB Ucensed Contractor I I SWRCB Limsed Tank Tesftr <br /> License Type: A Umnse Number:880430 <br /> Manufadurer Toning <br /> Manufacturroerr s Date'trainin es <br /> Caldwell Caldwell Level Indicator N/A <br /> 3. SUMMARY Of TEST RESULTS <br /> penent Pass PottT Nak R WW Made nt Fait Tested RWdh <br /> Annular 1 CI Sump 5 ® ® Q O <br /> Annular 2 CI ❑ ® O Sum 6 ❑ Z <br /> Annular 3 ® ® D ❑ UDC 1-2 INI El E3 CI <br /> Sec Pig2 1 ® ❑ QDC 3-4 t73 ❑ <br /> Sec Pipe 2 131 ® UDC 5-6 ® o a ❑ <br /> Sec Pipe 3 tzd O O D UDC 7-9 ® 0 <br /> Sec PiDe 4 D O ® UDC 9-10 ® ❑ ❑ <br /> Sec Pi e 5 ❑ UDC 115 ® ® ® D <br /> Sump 1 13 Q UDC 11-12a <br /> SUMR 2 ® ❑ O UDC 12-13a ® ❑ o <br /> Sump 3 ® UDC 13-142 O U <br /> Sumo 4 0 ❑ D 13 UDC 14-15a ® ® ® O <br /> If hydrostatic test was oerbTned.describe whM was done with Ift water aW completion of tw <br /> Flter*4 back into 500 oat water trailer. <br /> .R A <br /> CERTIFICATION OF TECHNICIAN RESPONSIEU FOR CONEXXTING THIS TESTING <br /> To the best of my know! ,the facts sated In ft dooment ate aommte ond In 00 compflarm wltth requirements <br /> Technieses SigDate: 1116109 <br /> EVZ9 39vd "7111H >tJf O EZ9EE6E Z99 9E'.0 Z 0 ti®Z/ZZ/tie <br />