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08/27/2012 15:50 (209) 465-4988 Henderson Maintenance Cc Page 218 0 SWRCB, January 2002 Page l Of 7 Secondary Containment Testing Report Form This form Is intended for we by contractors performing periodic testing of WTsecondary containmentsystems. Use the appropriate pages ofthis form to report results for all components tested The completed form, written test pracedres, and printouts from tests (if applicable), should be provided to the facility ownerloperatorfor submittal to the local regulatory agency. Facility Name. City Of Stockton - Corp Yard 1Date of jestitir. 417-12 Farilfty Address: 1465 E. Lincoln Stockton, Ca 95206 Facility Contact Maria Phone: 209-937-5642 Date Local Agency Was Notified of Testing: 4-0-12. Name of Local Agency Inspector (f present during tesft: n/a 2. TESTING CONTRACTOR INFORMATION Company Name: Henderson Maintenance Company - HMC 'ZOL167.3 to Technician Conducting Test: Charles Ferrucci Credentials: 0 CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester License Type: Technic ain Mangjac_turer Manufacturer License Number 856771 Trainjig Componeat Cs) Date Training Expires INCON TS STS 12.29 - ZOO bmg-L-PROD INE WE T MOM" DSL STP SUW If hydrostatic testing was performed, describe what was done with the water after completion of tests: Transported as test fluid, CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the bat of my knowledge, th Mt this do are accurate and in full compliance with legal requbvnexts Teanician's Si Date- bmg-L-PROD INE WE T MOM" DSL STP SUW IBM FbISPENSER3/4 MARINE) 0 87-V-AIPOR BUCKET If hydrostatic testing was performed, describe what was done with the water after completion of tests: Transported as test fluid, CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the bat of my knowledge, th Mt this do are accurate and in full compliance with legal requbvnexts Teanician's Si Date-