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2560 Sequel Avenue Ste 202 • <br /> Santa Cruz CA 95062 IT <br /> 1 „ <br /> T: 83 .475.8141 <br /> F: 831.475.8249 <br /> CA Lic#693807 A-HAZ B-HIC <br /> Secondary Containment Testing Report Form <br /> 1. Facility Information <br /> Facility Name: Valero 3698 Date of Testing: 09/0212009 <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: 0812712009 <br /> Name of Local Agency Inspector(if present during testing): Michelle Henry <br /> 2. Testing Contractor Information <br /> Manufacturer Component Expiration Date <br /> INCON Leak Detector 12/15/10 <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 NTI RM <br /> Secondary Piping:All X❑ ❑ ❑ ❑ ❑ -❑ ❑ ❑ <br /> Piping Sump:91 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Annular:91 ❑X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> CERTIFICATIZsted <br /> SPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge, oc ent are accurate and in full compliance with legal requirements <br /> Technician's Signature' ± , Date: 09/02/2009 <br /> Technician's Name' Jonatha Ocker <br /> lof7 <br />