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UNbERGROUND STOIRAGE <br /> SECONDARY + NTAINMENT ' TESTING REPORT FORM <br /> INFORMATIONTWWN NN <br /> Type of Action 0 installation Test 0 Repair Test [I Six Month Test 36 Month Test <br /> FACILITY <br /> cdary Containment Test! ! : ;Date 0' i <br /> 19 <br /> Business AS) <br /> r : II 1 <br /> r Pole <br /> Business Site Add ity ZIP <br /> usij <br /> 1 , <br /> ity <br /> 574 W. Grant Line ' I . I racy, CA 95376 <br /> k* * � - � . <br /> isennicianPerforming tne lost - . on e <br /> Phone <br /> Marco 1 I . - . <br /> i ! # 2435 Ext 2 <br /> Contractorfrank Taster License <br /> Icc Certification # ICC Certification Expiration Date <br /> * 8415074 0412712021 <br /> s <br /> Tank lDm (Sy tank number, ston9d pmduct, etc,) 4 Mil <br /> Tank <br /> ContWnMent <br /> ► t ■WIN■ Mil MtSIF® 5�.1, �� <br /> Nt <br /> Product <br /> 1 ■ <br /> t I Nd <br /> Tightness - Result <br /> F:i _ ■ yl - ■ ■ <br /> RemoteComMuMcation Test Result <br /> rr t <br /> Piping Containmenti r .1 l G 1 � �} [[� kdi tiY 4Uf > T ! j �l TJtb `llN [:3 rC i� l ��e'f"i'�\'3��12 I� h. <br /> _ �. r is .�$ El _. 3» ,71r< < t, ' ?r:ds ,:z'_3iIL s sY< <br /> Tightness Test Result N grTOM, ■ . K4 I k1fal IMIMEE= <br /> CommunicationResult ■ til ■ ►'t <br /> Vent Piping • r: s it C } ' z. �fif .. -�r z -^z*-•.rrr- +-.+tna ifi ss jz- rns i ■ <br /> tt <br /> —z_ .3.. ! . . . . ,_t..} . . '. .E �__.,:.... . •. .z�h• r y.J. ,::.?.i 7 ar , t P <br /> 5`� F4t <br /> . . . 'j. „Vapor ♦ PipingContainment k U 132A <br /> Communication Test Result MEN <br /> INN <br /> _ rF T � . 5 . . . ^ c . . {Nt <br /> 7 <br /> v , INI ..J...Communication Test Resultr t <br /> ■ Rim■ wtIm <br /> 7*'r- <br /> Turbine Product Piping 1bbb <br /> f. ;At 4..'^_'z."" f2-+ .aft <br /> WWWW <br /> s f , r S f Y * 1 S ' . a,,< r � 35�ct . tr ?rS it1� ;� <br /> ' _ - ■ <br /> 3< F <br /> .� i <br /> t' �, ,� 5 . � Tx S L df } 7. fi ,1 of <br /> fM -Ofm �`�'�us:,� t..�� I% : F.- ?�i..vuY_�r <br /> Vent I Transition Sump II) m <br /> ■Tightness Test■ ®� <br /> Result ■ ' _ +i ■ fog FDMt 111111111111116W ■ 1.,11 ' - ■ INC WE = <br /> 'rightness Test Result rAi JOB U I 2=1 MA , <br /> ■ ` e �I ■I - - - ■ law* lymy <br /> be eXplained In fheirmpective IICOon. <br /> I hereby certify that the secondary containment was tested in accordance with California Code of Regulations, titiq 23x! <br /> division 3, chapter 16, section 2637 and all the Information contained herein is accurate. <br /> UST Service Technician Signature <br /> RECEIVED <br /> ` til{ililf:l�ll «. 1 Aim <br /> � <br /> �IT + <br /> ■ 1 ■ <br /> It s 7 s s s <br />