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y <br />SWRCR, January 2002 (� (� <br />Ft <br />Secondary <br />bf7 <br />Secondary Containment Testing Report Form 2D04 <br />Stockton Service Station Equipment Co., Inc. EUlRMENIF{ <br />PERMIT/S_L '� <br />808 N. Union Street, Stockton, CA 95205-4152 (209) 464-8333 FAX (209) 464-8349 <br />California Contractor License 309105 A -C61/1)40 HAZ/HIC E-mail sssecona,nacbell.net <br />1. FACILITY INFORMATION <br />Facility Name: California Highway Patrol Date of Testing: 1/02/04 <br />Facility Address: 3330 Ad Art Road, Stockton, 95215 <br />Facility Contact: Lyle M. Phone: 209-943-8666 <br />Date Local Agency Was Notified of Testing: 12.31.03 <br />Name of Local Agency Inspector (if present during testing) <br />2_ TESTING CONTRACTOR INFORMATION <br />Company Name: Stockton Service Station Equipment Co., Inc._ <br />Technician Conducting Test: Randy Chadwick <br />Credentials: [X ] CSLB Licensed Contractor [ ] SWRCB Licensed Tank Tester <br />License Type: C -61/D40 HAZ/HIC License Number: 309105 <br />Manufacturer Training <br />Manufacturer Component(s) Date Training Expires <br />Smith Fiberglass Products Company N/A <br />3. SUMMARY OF TEST RESULTS <br />Component <br />Pass Fail Not Repairs Component Pass Fail Not Repairs <br />Tested Made Tested Made <br />Tank Annular Test <br />X <br />Secondary Pipe Test (Run #1) <br />X <br />Secondary Pipe Test (Run #2) <br />X <br />Piping Sump Test <br />X <br />Under -Dispenser Containment Test <br />X <br />Fill Riser Containment Sump Test <br />X <br />Spill/Overfill Containment Box #1 <br />X <br />Spill/Overfill Containment Box #2 <br />X <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements. <br />Technician's Signature: R.andV Chadwick Date: January 2, 2004 <br />Randy Chadwick <br />NOTE: ORIGINAL MAILED TO: San Joaquin County Environmental Health Division <br />