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From: 09/28/2017 13:30 #643 P.006/008 <br /> BALCHRE <br /> SEP 2 S 2017 <br /> Page 1 of 2 <br /> Spill Containment Testing ONMENTAL HEALTH <br /> DEPARTMENT <br /> s <br /> 1. FACILITY INFORMATION j <br /> Facility Name: 953 Tracy Fedex Ground Date of 9/18/2017 <br /> Facility Address: 5655 Hood Way,Tracy,CA 95377 <br /> Facility Contact: lose Jimenez Phone: (209)830-5254 ' <br /> Date Local Agency Was Notified of Testing: 9/11/2017 r <br /> Name of Local Agency Inspector(ifresent during testing): Stacy Rivera i <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Balch Petroleum Contractors&Builders,Inc. <br /> Technician Conducting Test: Elmer Mortem <br /> Credentials: X CSLB Licensed Conductor SWRCB Licensed Tank Tester <br /> License Type: A/B/C-10/HAZ License Number:396575 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> Caldwell Hydrostatic Sump Tester 12/1/2017 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> Diesel 1 fill bucket X <br /> Diesel 2 fill bucket X <br /> Biodiesel fill bucket X <br /> Notes: <br /> Testing water is recycled. <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: Date:9/18/2017 <br /> i <br />