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California SecoAry Containment Testing Aort Form <br />This form is for use by contractors performing periodic testing of UST secondary containment systems. The completed form, <br />written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal <br />to the local regulatory agency. <br />2. TESTING CONTMACTOMAW <br />il.Y• <br />to m -'4 •l oiu <br />'a <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />jjjjx i, S /�.�t��.0 .L" �R ?G7ESS C-R_ ' �c tc,mt � i<c ✓� lY�.c.�, S„��.>� <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS 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: c C — ^'� � Date: ;t , (0-0-3 <br />Pape 1 of 7 1/13/2003 <br />