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APR 22 2003 8:58AM H ASERJET 3200 0 P.1 <br />SWRCR, January 2002 <br />Page 1 of 7 <br />Secondary Containment Testing Report Form <br />Stockton Service Station Equipment Co., Inc. <br />808 N. Union Street, Stockton, CA 95205-4152 (209) 464-8333 FAX (209) 464-8349 <br />California Contractor License 309105 A -C61/1340 HAZ/HIC E-mail ssseco nacbetl.n <br />1- FACIT,TTV INFnRMATTON <br />Facili Name: City of Stockton I Date of Testing: rlarch 20, 2003 <br />Facility Address: 1465 S. Lincoln St., Stockton, CA 95206 <br />FacilityContact: Phil Burnside Phone: 209.937.i'417 <br />Date Local Agency Was Notified of Testing: March 20, 2003 <br />Name of Local A.Sency Inspector if present during testin j <br />2_ TRATINC. rnNTRArTnR MWIRMATin1V <br />Company Name: Stockton Service Station Equipment Co., Inc. <br />Technician Conducting Test: RanqX Chadwick <br />Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester <br />License Type: C-61/1)40 HAZ/HIC License Number: 309105 <br />Manufacturer Training <br />Manufacturer Component(s) Date Trahng Expires <br />kWl ►r LIa RW"f NO <br />Component Pass Fail Not Repairs Component Pass <br />Tested Made <br />Fail Not Repairs <br />Tested Made <br />secondary Pipe Test, Line #I, X X <br />Hoses #1 and #2 <br />If hydrostatic testing was performed, describe what was done with the water after completion if tests: <br />REPLACED BLUE -LINE 3 x 2 BOUT. RETESTED. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THM 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:1ZC_A1Q r\lh-L46z,�Date: March 20, 2003 <br />Randy C i <br />ORIGINAL FAXED TO: <br />• San Joaquin County Environmental Health District <br />• Copy Mailed To: City of Stockton Mr. Phil Burnside <br />