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f • <br /> 2560 Soquel Avenue SIR <br /> Santa Cruz CA 95062 I T <br /> T: 831.475.8141 F i <br /> F: 831.475.8249 <br /> CA Lic#693807 A-HAZ B-HIC <br /> Secondary Containment Testing Report Form <br /> 1. Facility Information _ <br /> r <br /> tality Name; Valero 3898 DateofTesting: 7/16/200cility Address: 153 E. 11-th ST. Tracy CA 95378 <br /> Facility Contact: Phone: 209.632-8815 <br /> Date Local Agency Was Notified of Testing: 0711312007 <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. Testing Contractor Information <br /> Manufacturer Component Expiration Date <br /> Incon Leak Detector 11/23/07 <br /> 3. Summary of Test Results <br /> Component P 1 F NT I RM Component P F NT RM <br /> Spillbox:All © ❑ ❑ ❑ ❑ ❑ ❑ U <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <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: �� r Date: 7/16/2007 <br /> Technician's Name: Frank Bohnet <br /> Iof2 <br />