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SWRCB, January 2002 Page I of 7 Secondary Containment Testing Report For 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 Facility Name: Verizon Manteca Central Office Date of Testing: 09/03/08 Facility Address: 430 W. Center Street, Manteca, CA 95336 Facility Contact: Masood Choudhury Phone: (909) 620-5962 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector Present (if present during testing): 3. SUMMARY OF TEST i Component Pass Fail Not Tested Repairs Com Component Made p Pass Fail Not Tested Repairs Made Supply & Return Line (Polisher) ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ Supply & Return Line (Generator) ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ Supply Line (Polisher) ® 1 ❑ ❑ 1 ❑ ❑ 01 ❑ 1 ❑ Piping Sump ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ Fill Sump ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ Spill Bucket ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ Tank Interstitial ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ in ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ ❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: Transported to next test facility. 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: 09/03/08 UU Revision: