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2560 Soquel Avenue Ste 202 04 ,Santa Cruz CA 95062 T: 831.475.8141 RIT <br /> F: 831.475.8249 <br /> CA Lic#693807 A-HAZ B-HIC <br /> Secondary Containment Testing Report Form <br /> - 1. Facility. Information <br /> ---_ <br /> Facility Name: _Valero 3698 Date of Testing; 5/2312007 " <br /> :Facility Address: 153 East 11th Street,Tracy CA 95376 ---- : <br /> Facility Contact: ----- -"--- ---- --- <br /> _.. Phone: 209.832.8815 <br /> Date Local Agency Was Notified of Testing: 05/2112007 - --- --- <br /> ane of Local Agency Inspector(If present during testing): I <br /> 2. _Testin2Contractor Information --— <br /> Manufacturer Component <br /> Expiration Date <br /> Incon„ _--- -_- Leak Detector 11/23/07 <br /> i—- ------—_.-_-_.-.._-----------.-.._ --- 3. Summary of Test Results <br /> Component P F NT - RM Component P F NT RM I <br /> Spill Buckets:All ❑X ❑ ❑ ❑ ❑ ❑ ❑ 0 <br /> 0 El <br /> ❑ _-o—o <br /> ❑ ❑ ❑ ❑ _ E ❑ ❑._ _o . <br /> El 0 El El <br /> 11 El 0 El ff EY 0 If <br /> CERTIFICATION OF TECHNICIAN RE PONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of ney knowledge,the facts stated in this d cr t wit are accurate and in full Compliance with legal requirements <br /> Technician's Signature: Date: 5/2312007 <br /> Technician's Name: Ulises Nogueron <br /> 1of2 <br />