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r <br /> f r <br /> SWR(M,Januaty 2002 lag® Cff <br /> Secondary Containment Testing epnrt Form <br /> Msform is intended for.use..by contractors por fibming lzedodta kWog gf.UST secondary contM ent-sy iems. Ilse the <br /> appropriate pages of f th sform to report results far all.components feted 77ie costed'farm er-tW praeeriiere&rand <br /> prarrtoutsfroru tests#f applicable),should be -the.locaingnfatar agency. <br /> 1. <br /> Facility Alansa: Cii .�f t laio?; o xatiriti Y'srtl Nte..of:,7esfinw. nl.�4,..'ZQi5 <br /> Fadliby Address: 1465:Em la Street.,. kion,Via:95 <br /> Facility-Contact: MadaLaos [Pbond: '(20q)Z7-!8060 <br /> Date.l:, aI AgB y W1as Notiified ofVeAin&: Aft/=5,tier Mord`k Test <br /> Name of Local Agency Inspector(fpresebt dur .tesh)t <br /> Company Name; MD.Ccmplianca Testing <br /> Technician Conducting Test: Benjamin T.Duncan Jr. <br /> Credentials: U CSLB Licensed Contractor X 9VVPXBJAwnsed Tank-Tester <br /> License Type: Tank Tester )t.fce�nsse;lxlaber:l (i 112Qf1G:# 3 - T <br /> ' Manuf�ettura>°�. i9)itta <br /> Manufacturer Co. n:�; Data Tsai its <br /> Caldwell S steaxis P .in Jul,12QI6 <br /> 3. SUMMARY OF TEST RESULTS <br /> ( Co"OnentPAS fail 1rDt. ttepatrs A+tot R pati <br /> Tested MA&. trot�uiienf Paps'Feil Tedted Made <br /> Seconder Pipe,41 U. U U U: U U U <br /> Seconder Pipe#2 X .0 'G G 0 G. <br /> Secondary Pipe.#3 p ❑ D MJ. G ❑ G <br /> Secondary.P`ipe#4 U, L] U U . U U. U <br /> Piping Sump#€l x LI L] .Ll U.; L.. U .0 <br /> Piping SUMP#2 x U Li W U. L'. U U <br /> Pispenser Sump.#l&I El 11 D n D D ❑. <br /> Dispenser Sump 43&4 X U. U U Li: U U U <br /> Dispenser Sip#5&6 X U -Li U U. U U U <br /> Dispenser.Sump.#7&S x U ;LJ ll U U` LJ U <br /> 0 ❑ 0 II G D D ❑° <br /> D ❑ ❑ <br /> IfHydrostatic tvsting.'was pgifww6d,describe;what :.. 'pne' ithjhw w*.a fir.cotnplation attests:. <br /> To$t-Plutd�!pplted and kecoyered fbr rouse b3`x.. •,: `I irC `IyAiOW <br /> CERTIFICATTON 0}?TF.CHNIr_ N N L,1~ <br /> To.thebest ofmyknonrledge;.tlte ae �slatsit li rhes dt�'i ntefi_ark:dpxn9e:.::.} a: ai rltpfiri Kae fi to l<re tt kern is <br /> T.eciiniaion's Signature: rMw .. Dato: April 14, 17T5. <br />