Laserfiche WebLink
RECEIVED <br /> SWRC$,January 2002 JULPage 2011 f <br /> Secondary Containment Testing Report F'MIRONMENTAL HEALTH <br /> This form is intended for use by contr actors performing periodic testing of UST secondary containment sy@@IPPWWNT <br /> appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and <br /> S'intouts from tests(if applicable),should be provided to the facility ownerloperator for submittal to the local regulatory agency. <br /> �1t�. 1. FACILITY INFORMATION <br /> Facility Name: Vanco I Date of Testing; 7/20/2017 <br /> Facility Address: 1330 W Charter Way Stockton Ca 95206 <br /> Facility Contact: Mike Popari Phone: 916-936-1665 <br /> Date Local Agency Was Notified of Testing:Called <br /> Name of Local Agency Inspector(if present during testing):No <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Elite IV Contractors <br /> Technician Conducting Test: Mike K <br /> Credentials: X CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type: ICC CA UST Service.Tech I License Number:00015745 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> Phil-Tite Spill Containers 7/20/2017 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fall Not Repairs <br /> Tested Made Tested Made <br /> 87 Spill Container X <br /> Diesel Spill Container X <br /> Diesel Spill Container X <br /> 91 Spill Container X <br /> 100 Octane Spill Container X <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Barreled—To be reused <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the facts stZZ:;;:2accurate and in full compliance with legal requirements <br /> Technician's Signature: Date:7/20/2017._ <br />