Laserfiche WebLink
Sbp� 1°S 02 08:19a Elite Iv Contractors Inc 2094616342 p.2 <br />0 DC SWRCB, January 2006 <br />IWO Testing Report Form <br />.This form is intended for use by contractors performing annual testing of LIST spill containment structures. The completed form and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACU= WFORMATION <br />2_ TF.STmt-rnNTRAVTn t TNPARX4A'rinlV <br />CorapanyName: EL17 l <br />Tecbnicm' Conducting Test P t K <br />Credentials': O CSLB Contractor ICC Service Tech. D SWRCB Tank Tester D Other (Specify) 5EJ. J f 1 i 1Cti f? <br />License Numbers): j 07 <br />3_ SPILL BUCKET TESTING INFORMATION <br />CERTIFICATION OFTE TIG. <br />CIAN RESPONSIBLE FOR CONDUCNG TMS TESTING <br />1 hereby c trtj5- that all the information. contained inthis, report is true, accurate, and in. full compliance with.legal. requirements . <br />Technician's Signatur Date- 9'Ko <br />i State laws and tegulations do not currently require testing to be performed by a qualified contractor. However, localrequiremients <br />may be more stringent. <br />