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.C.owa RECEIVED <br /> J" OCT 0 3 2017 <br /> ci xv <br /> Page 1 of 2 <br /> Spill Containment Testing ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br /> 1. FACILITY INFORMATION <br /> Facility Name: 953 Tracy Fedex Ground Date of 9/18/2017 <br /> Facility Address: 5655 Hood Way,Tracy,CA 95377 <br /> Facility Contact: Jose Jimenez I Phone: (209)830-5254 <br /> Date Local Agency Was Notified of Testing: 9/11/2017 <br /> Name of Local Agency Inspector(ifpresent during testing): Stacy Rivera <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Balch Petroleum Contractors&Builders, Inc. <br /> Technician Conducting Test: Elmer Mortera <br /> Credentials: X CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester <br /> Liccnse Type: A/B/C-10/HAZ License Number:396575 <br /> Manufacturer Trainin¢ <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 /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ C <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ I <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Cl ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ �7— ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <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 />