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APR-30-2010 FRI 05: 41 PM P. 037 <br /> 04/29/2010 09:56 209943 APEC �X� btrc' PAAE 01/83 <br /> (�g <br /> SWP.CS,aanuaTy 2w- Page of <br /> secondary Containment Testing e rt Form <br /> rha forts is huen*d for use(gyp cyo?L,=t0rx tearing of USS s Use the <br /> appropriate pages of this form t®rePort re uAs.for all cmponents toted 77je completed fornk written rear proc es,and <br /> printvttta.from tests(if applicable),should be provfded to the f bCUV ownu'/o exator for subrrrfrtdl to the Eocal reguiatory agency. <br /> 1. FACILMYII�FFO TxON <br /> Fa�cilir/Name: TRACY TRUCK STOP Date of Testing: 4-I2�IQ <br /> Fadfity Address: 390 N.T,K,ACY'BLVD,TRACY,CA.43396 <br /> F�ilaty C DEBBIE !'boas: (209)832 5006 <br /> D=Local Agency Was Notated of Testing 4-9-t0 I <br /> Nome of Local Agency IksS,i?eatos rsent dstrit,R testinO: STAGY PJVERA � <br /> 2. Tgt CONTRACTOR INFO ,A'ti'ION <br /> COTPMY'Nme: SST-Scevice StwomTcstezi <br /> Todakian Conducting Test- Heath A.McFver <br /> Credentials: D CSLB Licensed Conawwr X SWRC3 Licensed'FattkT j <br /> 1 icew Type: Service Teanicim Lice=Nuro6er: 04.1677 <br /> Man af'ti'raenln� { <br /> M eY Cpery en S Data Training B <br /> UNKNOWN 87/91 ANNULAR SPACE 22�&13 f <br /> OPW 87 FILL BUCKET 2-29-13 <br /> 3. SUrvjbLkKY OF TEST RESULTS <br /> wot Reg9irs <br /> comporWw �A� foe <br /> campoae 1Fa;t T Tested 1e~a <br /> 87/91 ANNULAR SPACE X ❑ 0 C is C <br /> 97 MLBUCKUT X C LC Ll C <br /> rr` �� C1 G G i'• <br /> Fol <br /> 0 <br /> 1 <br /> U 'a + IM G C 7 <br /> C ® r� 0 <br /> if bydwswkttsting was parformAd,descn'bc what Ives dons with the water ktion Oftests: <br /> LEFT ON STM <br /> CER CATION OF TE AN XESp0NSt8j.E FoR CO3N D3UCTt;YG . S TE.'S'7nt�G <br /> To the beat of imay kn daefaegs b documma ase avwrm asd In fdl comb ' to with legal <br /> Technician's Signature: „� Dau --- <br />