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SWRCB_Januarv-2002 Pane 1 . <br /> Secondary Containment Testing Report Form <br /> This farm is intended for use by contractors performing periodic testing q/ Use the <br /> appropriate pages of this form to report resruhs for ax all co �onents tested. The completed form, wrl.nen test procedures, and <br /> printouts from tests (if applicable), should he provided to tIe facility owner/operator for srrbmitlul to the local regnlatorlv agerrcv. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCO #05450, CC 18022647 Date of Testing: 05/02/2007 <br /> Facility Address: 1617 W. FREMONT STOCKTON, CA, 95205 <br /> Facility Contact: DEALER/MANAGER Phone: (209) 462-1617 <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> Technician Conducting Test: DENNIS RUE <br /> Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type: I License Number: <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repair <br /> Component Pass Fail Tested Made Component Pass Fail Tested M <br /> ade <br /> Spill Box 1 REG FILL M ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Spill Box 2 REG FILL X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Spill Box 3 PRE FILL ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ El ❑ ❑ ❑ ❑ ❑ El- <br /> F-1 El ❑ El <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ I IE]- ❑ ❑ ❑ <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 <br /> document are accurate and in fill compliance with legal requirements <br /> Technician's Signature: ttr, `. �"' �9 Date: 05/02/2007 <br />