Laserfiche WebLink
2560 Soquel Avenue Steo <br /> Santa Cruz CA 95062 I T <br /> T: 831.475.8141 i' <br /> F: 831.475.8249 <br /> CA Lic#693807 A-HAZ B-HRC M61=01 I M1141 11610 <br /> Secondary Containment Testing Report Form <br /> 1. Facility Information <br /> Facility Name: Valero 3698 Date of Testing: 07108109 <br /> Facility Address: 153 E. 11th St. Tracy CA 95376 <br /> Facility Contact: Phone: 209.832-8815 <br /> Date Local Agency Was Notified of Testing: 07102/2009 <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. Testing Contractor Information <br /> Manufacturer Component Expiration Date <br /> Incon Leak Detector 12/15/10 <br /> 3. Summary of Test Results <br /> Component P I F I NT I RM Component P F NT RM <br /> Spillbox:All ❑x ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> CERTIFICATION OF CHNICIAN RESP NSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the fa s st ted in this ocu are ur a and in full compliance with legal requirements <br /> Technician's Signature: MAI Date: 07/06109 <br /> Technician's Name: dff <br /> Iof2 <br />