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MCI(, Jahtia y 2002 <br />• Page I of 7 <br />Secondary Containment Testing Report Form <br />Stockton Service Station Equipment Co., ttic. <br />808 N. Union Street, Stockton, CA 952054152 (209) 464-8333 FAX (209) 4644349 <br />California Contractor License 309105 A-C61A)4011AZ/HIC E -moil sssecof wbcll.net <br />1 _ FA rii .rTV tnvVnD%X A TTniv <br />Facili : Idatne: Ci!j of Stockton, Corporation Yard v Date of Testin ril 9.2009 <br />Facility Addtess: 1465 S: Lincoln Street, Stockton, CA 95206 <br />Facility Contnct: Teri Williams Phone: 209.937-7416 <br />Date Loral Agency Was Notified of Testing: <br />Name of Local Agehcy Inspector (if present durinA testing) Rav Von Fine <br />� Ti!CT�ttvr_ �-niv�rn ♦/•Mnn .wr��.n�....-...�, <br />Cont Name: 9tticktod Service Station Equipment Co., Inc. <br />Technician Cdridltetitig Test: Mark Henderson, California UST Service Tech #XX4141014045 <br />Credentials:. (X) CSLB Licensed Contractor SWRCB Licensed Tank Tester <br />Licrinse Type: * C -61/D40 HAZIMC i.icense Number. 309105 <br />Mghtlftleturgr <br />*A- CUiI MA1RV AW TTQT r> VQTYr Irc <br />Date <br />Cn,hpane t <br />Pah Fail Not <br />Testtd <br />Repairs Component Pao+ Fed Nnt Repairs <br />Made Tested Made <br />Skcgirda .PIR Testi <br />P e 3 <br />X <br />X <br />Pi hi s6m Teltt <br />Pan 4 <br />x <br />X <br />(fridtr-D11 cora C.nntsih. <br />Pnee 5 1 <br />X <br />X <br />Spill/Overfill Cddthia. <br />rage 7 <br />X <br />X <br />Li n.yunrauHuc icsunK wwa Pcrivrmcu, ueacr ue wna[ was cone wRn tue water atter comptetinn of tess": <br />PAGES I tend 6 NIA <br />Pert Rosh; Faxed dt Wiled to: SAN J0AQI)1N CO. F,INVIRONMENTAL [TEA I TH DEPT., MR. RAY VON FLUE <br />CiTY oiSTOMON, MiS$ TERI WILLIAMS <br />CPh'ttF/CATION OF TECnMCtAN RESPONS NIX FOR CONDUCTING THIS 11ti'ING <br />To the hest afmy knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Sigriature: Nark Aenderson _ nate: April 9, 2009 <br />