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SWRCB, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION FacilityName: CONOCO PHILLIPS #2705447 DateofTesting: 07/11/2008 Facility Address: 1469 E HAMMER LANE STOCKTON, CA, 95209 Facility Contact: MANAGER - TOM Phone: (2 0 9) 478-1522 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: JARROD COOKE Component Credentials: CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester ��00 License Type: a Manufacturer License Number: 743160 Manufacturer Training Component(s) Date Training Expires tanknology all 07/17/2009 Pipe 1 SUP SUP 3. SUMMARY OF TEST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: 07/11/2008 Component Secondary P• - 3 I�ry�Secondary ��00 Pipe 1 SUP SUP �■■■�■�■�a000 000 ■ 0000 �000 ■ ■■0000 _ 0000 �■�a000 0000 0000 � 0000 �■ 0000 0000 � 0000 � 0000 0000 ■ 0000 �0000 ■0000 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: 07/11/2008