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Sep 29 02 03: 44p Elite Tu Contractors Inc 2094616 4 p. 6 <br /> SWRCB.January 2002 Page 1. <br /> Secondary Containment Testing Report Form <br /> Thio furor is intended fiu rrrr hj ca»trtattUr�prrforntireg pt riudiC trsdng of UST retYr+tdary conttaidrrreru xvste►rts. Ux0 rAr <br /> appmpria/e papa of this form to report rrralix for all cumpprrnenn trshd. Tla:•cotmplered form, written test prrxw/ure'e,urrd <br /> prrntuuta jmm trstx(rfapplie uhlc�j,shouhl be piovidetd ro the far.Uily uwnc:r/npera►or_for.>uhraittal to the local rt texlalan aK<m v_ <br /> I. F'ACILI'TY L` FORMATION <br /> Facility Name: FLYING J 0500075 Date 0fTerting: 08/01/2008 <br /> Fxciljty Adtim s: 1501 N. ,TACK TONE RU RIPON, CA, 95366 <br /> Futility(:ontact: JOSE: Phonc (209) 599-4241 <br /> Date Local Agcocy Was Notified of Testing: <br /> Nmnc of focal Agency Inspector.(if present during texting): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TANKNOLOGY, INC. <br /> T=hnician Conducting Tint: JARROD COOKS <br /> Crudcatials: x CSLS Licensed Cu»tractor S WR(B Liccn-x-4 Tank Teter <br /> Licemic Typc: a Liom%c is umber: 743160 <br /> Manufacturer Tmininr <br /> MsnuiauAurer Componctd(s) Date Training Expims <br /> t:anknology a1l 07/17/2009 <br /> l / <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repair% Not <br /> Component Pass Fa:l TestedFr--1 <br /> Coaapt>•eae Paas NRiI Not <br /> Rcpai <br /> spill UQX 1 OIr: PILL X ® D � ❑ <br /> �P.;.:z 1 nax 2 am t•j R.T. � ❑ C] C� ® ❑�� <br /> .pill ocoL 3 AIF FILL ❑ ❑ <br /> ❑ P I ❑ ❑ <br /> ❑ ® ❑ ❑ ❑_ ❑ <br /> ® ® ® I ❑ ❑ El <br /> ❑ ❑ ® ❑ ❑ El ❑ <br /> ❑ n ❑ ❑ ❑ a ❑ <br /> [ ❑ ❑ ® HCl ❑ C7 <br /> Elf-] Cl - ❑ o ❑ ® <br /> If hydm%tatie teaittg wns performed,dcs-cribc what was dant:with the avatar after comphfitxt of resm <br /> !ir ttrc firsP of rm•1cnuWlCr�c.thr facts stated in this docurwcirt arc•crccuratcr,fnd irr./u:l cwnr,cliurcr with lcy;rrt rr�grrinrnc•n;�' <br /> r <br /> Tcsftnician`s SiL,etaluret _`%"!�'` _..., r}atc:- <br /> . <br /> g d <br /> e07:80 80 ZZ d®5 <br />