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I Feb -26. 2013 10:29AM <br />SWRCB, January 2002 <br />RUMEX CONSTRUCTION No -8254 P, 2 <br />0 0 Page _ of <br />Secondary Containment Testing Report Form -(S 989) <br />This form is intended for use by contractors performing periodic testing of USTsecondary containment systems. Use the <br />appropriatepages of dais form to report results for all components tested The completed form, written test procedures, and <br />printouts from tests (if applicable), should be provided to the facility ownerloperatorfor submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: STOCKTON CHP I Date of Testing. 2/22/13 <br />Facility Address: 3330 AD ART P.D. STOCKTON. CA 95215 <br />Facility Contact: JIM MURRAY �]Phone: 209-943-8666 <br />Date Local Agency Was Notified of Testing: 12/10/12 <br />Name of Local Agency Inspector {if present during testing): GARRET BACKUS <br />0� I okly 9 lorerKON 9 ZI-XIO <br />'Company Name: Rumex Construction Corporation <br />Technician Conducting Test: EIVIND BYE <br />Credentials: 21 CSLB Licensed Contractor SWRCB Licensed Tank Tester <br />License Type; A, B, C6 I /D28, HAZ License Number: 872234 <br />Manufacturer Training <br />Manufacturer Component(s) Ditto Train'R& ]Expires <br />Franklin Fueling INCON Sump Test UST 9/20/14 <br />State Cal. ICC UST Service Tech, 5/19/14 <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />IT WAS DISPOSED OF AS HAZARDOUS WATER AND TAKEN <br />CERTIFICATION OF TECHNICLAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1'o the bat of my knowledge, th etom stated <br />.., ��Jmthft cumew are accurate and In full compliance with legal requirements <br />::F7 <br />Technieian's Signature- Date, 2M113 <br />Component <br />I've J., <br />Few <br />v000 <br />���rar�oo <br />vaoo <br />o�oo <br />87 FILL BUCKET <br />vo■�r•� <br />o000 <br />87 VAPOR BUCKETvo©o <br />o <br />'0000. <br />o, <br />v000 <br />sago <br />�000, <br />©opo <br />0000 <br />a000 <br />0000 <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />IT WAS DISPOSED OF AS HAZARDOUS WATER AND TAKEN <br />CERTIFICATION OF TECHNICLAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />1'o the bat of my knowledge, th etom stated <br />.., ��Jmthft cumew are accurate and In full compliance with legal requirements <br />::F7 <br />Technieian's Signature- Date, 2M113 <br />