Laserfiche WebLink
t A11% <br /> G_ 2560 Sequel Avenue Ste 202 - <br /> Santa Cruz CA 95062 _ <br /> T: 831.475.8141 - <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: 07/1112012 <br /> Facility Address: 153 East 11th St.Tracy,CA 95376 <br /> Facility Contact: Phone: 209.832-8815 <br /> Date Local Agency Was Notified of Testing : 06/2812012 <br /> Name of Local Agency Inspector(if present during testing): Thuy Tran <br /> 2. Testing Contractor Information <br /> Manufacturer Component Expiration_Date <br /> i.. - INCON - - TS-STS 1211312012 <br /> 3. Summary of Test Results <br /> Is this a retest of previously failed components?0 YES <br /> - - - <br /> r --- -.— p F NT RM Component -L P ]_ F NT IRM <br /> Component _1- _ _ _ � __ <br /> ❑ El El 11Spill Buckets:872&91 X❑ ° ° ° - - <br /> El ❑ ❑ ❑ <br /> Spill Buckets:871 0 ❑ ❑ ❑ - - <br /> ❑ ❑ ❑ ❑ -- - - -.. <br /> --- --._. _-._._ _. _.. _ _ . . --❑ 11 ❑ El <br /> El El El <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ -o <br /> El El <br /> - ❑ ❑ ❑ o <br /> ❑ ❑ ❑ ° <br /> TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> CERTIFICATION OF in thi ocument are accurate and in full compliance with legal requirements <br /> To the best of my knowledge,the acts stated <br /> Date: 0711112012 <br /> Technician's Signature'' <br /> Technician's Name' Jonath n Ocker <br /> I of 2 <br />