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May 26 09 10: 00a Elite Iv Contractors Inc 2094616342 p. 2 <br /> :WR`'I),January 2002 Page_a. of 1 <br /> Secondary Containment Testing Report Form <br /> Mi-i f v ne ie irthwiletifur wive ht-6 fndtrue/# VpeffiwnrNl):jhnits/iv 14'.Ring of(,t%-r t 4:ud)dul;v coswuhument si-m-mv. I Ive dw <br /> U/)flpldt►P#d/t•(hr,`rati t f dld/1'1r1P/Ir rn IglhN'r P.:efl(f.1/ere elll a�emtisuMnP•e rs'.vlttr� ?ftty 6tiddrrpl6"/a"r//OPm, {Nrl1B(•n lrtxl pr'N6'e'<hfI'r'c,U/hl <br /> f.>P'ieetuelLe fYreen errLe (il aeppliaeeh(a1. s(rUtl(t`/rCldrfrlitiial ted rhp`uc•i/1/V#fr'q✓r.�irprrf"/t,1W?ddhm(dlrJl(tl r/(d if)r'Ui rt�t;IdtJf�l�tdj;cPre'y. <br /> I. FACILM INFORMATION <br /> I Lenity Name_ C'a+u..A•✓ r-I es W4 a S .sa nate uf'festin tl <br /> I'+u aloty Addre+x: �1 t� v In �.�✓ )Q_a �Vn�-l'*'�-t ' <br /> F;1ciliry C'untxc ,�-cyri_S'i - S q rea�n 'v' � �. <br /> -T?rr1(:Low!Agency Wns Nutifred of Testing: Z fo 0 <br /> Nume of I.ete:al Ags;atey Inspector(rf pPdeunt.Jcsrinx testiovy). <br /> 2. 'rg41'ING C.ONTRAC OR INFORMATION <br /> 'rechaician Cmducting !'ext: (#.v, d w.,,n . ti K Q✓e , __ .-...._.._� <br /> `CPztkmirlls. _t.r CSLB Licensed Cueatn;;t w r WRCH Lensed Tank T-ne:r. .� <br /> t.ia sncr TypC:j c<.a!c_ rg}� �I Liccnsc NumOet:7l� i ItU !c 5� yk Ad _L( <br /> M n to r T i ' <br /> manufacturer Com uncrU s Date Training Exires <br /> I SUMMARY OF TEST RESULTS <br /> C'o r►ee®r Pia Fait Nof Csmp Pwa Fntl Not RepaIra <br /> TOW feared &alc <br /> ty3,y i..► u t i <br /> — 1 <br /> ul, j66 <br /> - <br /> -�c c.u�,�:r.r �� ?R._t. .. . ._ ..._ � r ► �1� �.. /®r�L r I _: I I I <br /> ee _ <br /> 12S <br /> tf <br /> r r'hytfroIII tes(+f19 1%35 Pufrsrmed.describe what was done will'1 Ilse av;jeer atter compkilon of cetits: <br /> s ... =/1I .��: c ✓� - ,- /1 e! �J.JGsM[� ressr�l <br /> ('E.RTIFsr.,%poN OF'TE:CIINIC:IAN RFSn)N.IH4F FOR(:oNDUCTIN[: This FESTING <br /> rip the hewf a/ms•APM lewjre did furls stifled in tltls r! .0 aent fare artweare tenet In fail ce)ntplignee 1r+11h(rgrdl Pt y#/®`rrurnn <br /> )lla:: 3 l �� 10e,1 . 1 y . <br /> v <br />