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2560 Sequel Avenue Ste2 2 <br /> Santa Cruz CA 95062 j I •r1_ <br /> T: 831.475.8141 <br /> F: 831.475.8249 <br /> CA Lie#693807 A-HAZ B-HIC <br /> Secondary Containment Testing Report Form <br /> 1. Facility Information <br /> Facility Name: Valero 3698 Date of Testing: 0710712008 <br /> Facility Address: 153 E.11th St.Tracy CA 95376 <br /> Facility Contact <br /> Phone: 209-832-8155 <br /> Date Local Agency Was Noti0ed of Testing: 07/02/2008 <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. <br /> Testing Contractor Information <br /> Manufacturer Component Expiration Date <br /> 3. Summary of Test Results <br /> Is this a retest of previously failed components? ❑YES <br /> Component P F NT RM Component P F NT RM <br /> Spnmox:All ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Fill Sump:All ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Turbine Sump:All ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Annular.All © ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Secondary Piping:All © ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> UDC:All ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <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: J / <br /> -0 Date: 07/07/2008 <br /> Technician's Name: Jeff Duran <br /> 1 of 7 <br />