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9 0 <br />SWRCB, January 2002 Page of <br />SecondaryContainment Vesting Report Form <br />This form is intended for use by contractors performing periodic testing of LIST secondary containment systems. Use the <br />appropriate pages of this form to report results for all components tested The completed form, written test procedures, and <br />printouts from tests (f applicable), should be provided to the facility ownerloperator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: RYDER FACILITY LC -1071 Date of Testing: 2/28105 <br />Facility Address: 3633 DUCT{ CREED DRIVE, STOCKTON, CA 95202 <br />Facility Contact: AMY WHITE Phone: 713 426 4800 <br />Date Local Agency Was Notified of Testing: 2/22/05 Test Type; 6 months <br />Name of Local Agency Inspector (ifpresent during testing): <br />1) Tvei mV_ i-nNTR Ar T"R INFORMATION <br />A CIiMMARV OF TFST RESULTS <br />Component <br />_ �_ __•---- <br />Pass Fait <br />N°otRepairs <br />Tested Made Component <br />Pass <br />Faii <br />Not <br />Tested <br />Repairs <br />Made <br />T-1 Fill <br />X ❑ <br />❑ ❑ T-4� Fill <br />X <br />❑ <br />❑ <br />❑ <br />T-1 STP <br />X ❑ <br />❑ ❑ T4 STP <br />X <br />❑ <br />❑ <br />❑ <br />T-2 Fill <br />X ❑ <br />❑ ❑ T-4 Secondary <br />X <br />❑ <br />❑ <br />❑ <br />T-2 STP <br />X ❑ <br />Cl ❑ T-4 Secondary Vent <br />X <br />❑ <br />❑ <br />❑ <br />T-3 Fill <br />X ❑ <br />❑ ❑ Dispenser 1 12 <br />X <br />D <br />❑ <br />❑ <br />T-3 STP <br />X ❑ <br />❑ ❑ Dispenser 3 / 4 <br />X <br />❑ <br />❑ <br />T-1 Secondary <br />X ❑ <br />❑ ❑ Dispenser 1 Slave <br />X <br />❑ <br />❑ <br />11 <br />T-1 Secondary Vent <br />X ❑ <br />❑ ❑ Dispenser 2 Slave <br />❑ <br />❑ <br />❑ <br />T-2 Secondary <br />X❑ <br />a ❑ Dispenser 4 Slave <br />❑ <br />Q <br />❑ <br />T-2 Secondary Vent <br />X ❑ <br />❑ ❑ Oil Transmission Sump <br />F <br />Cl <br />❑ <br />❑ <br />T-3 Secondary <br />X ❑ <br />❑ ❑ Antifreeze Line 1 * <br />❑ <br />❑ <br />❑ <br />T-3 Secondary Vent <br />X <br />n ❑ Antifreeze Line 2 * <br />=00 <br />❑ <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />* Line 1 from building to transition sum * Line 2 from transition sum to reel Island. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, th cis stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: Date: <br />