Laserfiche WebLink
r <br />SecondaryContainment Testing Report Form <br />This foi rni is intend ed loo use 17), {'<1luructo % pel fCli-miFdgl'7eriodic It 5"Olg (7F � �� 3'64'()F7s�(dt'�' c-onfaini7 ent sYstenis. L se the <br />appropriate page's rtf thh fiwf? to report resiths far Lill cOtlpone als teved 1 he c'omplete>tl_l« rai, written lest 1 roved"res, and <br />lWintouls',fi.ratn testy (iff pplic ble), should he provided lo the fcic:ilill, c wnet-'apcl'aforrtvr subminal to the local regal moot agenc;v. <br />1. FACILITY INFORMATION <br />;x <br />Date of `i tstin : 11/112012 <br />Caeahts�:an�e. C�C(�i�C.E i�ASi-IIiTA TRUCKING_._ <br />Facility Acfclress. 1725 ACKE RMAN )I2, LO131 SAt �It)A( [J1S <br />County <br />_. ..�._ —_ � ---, _._ — ._ .__ .. _. _ �,x.__ _ _ . <br />Facility C. ojitact_ K L .I 1 Phone 20 368.0603 <br />Date Local Agency net 'as Nc�tit eci c�f'Tcstln� : I t3tSBi 14, Aqust 28,201.2.,",-, <br />__ W.._ n. __�_ <br />Name.. ert� Local Agency Inspector (itIPr€sew during iestin)N/A <br />Company <br />'`Technician Conducting "Gest: <br />Credentials: Z CS11LB <br />,., <br />Manufacturer <br />INCON <br />Component <br />IDSI I S I P <br />MIA SI:C; PIPING <br />UDC I <br />........_.._[111.1 ---,DC ? <br />ES INN CONTRACTOR TOR INFORV1ATION <br />veer Station Maintenance <br />_ - ..._._ ...._._.. <br />KELVIN 11-1..-, CRUZ <br />...._ ..... <br />sed Contractor ;WRC B I...icensed "I'ank 'fester <br />License Number: 433159 <br />l�lanuf�etn�-e'r `i`rainn <br />C c�anancrat{s7 <br />IS -STS <br />3. SUMMARY OF TEST <br />Not tbrtxasts <br />1 x E all '1',stcc Made <br />RESULTS <br />Component <br />DSL -2 STP <br />I)SI 2 SI~C` PIPING <br />_ � _...... ..�.. ........ <br />UI)C- I SAT <br />It hydrostatic testing, was performed, describe what was (team. with the -water after completion of tests: <br />T60, K AS "I S"I` r'A i"ER <br />I�at�; "B''sttnsn <br />m. ( A <br />Pass� Fail Not <br />Tested <br />CERTIFICATION OFTECHNICIAN ECIINICCIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the hest of nry knowledge, diefrtc:ts slated in this document are accurate and in jall compliance with legal require^ ae #a <br />Technician's Sigjiaitlre; Date: I I 1/')012 <br />Secondar,- Containinera test Resulls <br />I of 6 <br />