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Page 1. <br /> SWRCB, Januar, 2002 <br /> Secondary Containment Testing Report Form <br /> ting rocedures. and <br /> This form is intended for use by che <br /> ont orttresults for all components tested. The completted form UST secondary pwrittenal he locest al reg lattory agencv, <br /> appropriate pages of this form to rep <br /> printouts from tests(if applicable),should be provided to the facility owner/operator <br /> for 1. FACILITY INFORMATION 07/11/2006 <br /> Facility Name: ARCO 2076, CC 18022641 <br /> Date of Testing: <br /> Facility Address: 800 KETTLEMAN LN PTO N-85, LODI, CA, 95240 <br /> (209) 334-3678 <br /> Phone: <br /> Facility Contact: MANGER <br /> Date Local Agency Was Notified of Testing <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TpNKNOLOGY, INC. <br /> Technician Conducting Test: <br /> JOEY MESA <br /> ❑Credentials: CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Number: <br /> License Type: <br /> Manufacturer Trainin:; Date Training Expires <br /> Manufacturer Component(s) <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repair <br /> Not Repairs Component Pass Fail Tested Made <br /> Component Pass Fail Tested Made El <br /> El <br /> ❑ <br /> Spill Box 1-91 X ❑ ❑ ❑❑ ❑ <br /> Spill Box 2-87MAST ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Spill Box 3-87SLAV ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Spill Box 4-87SYPH ❑X El ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ El ❑❑ ❑ ❑ LJL Li <br /> El 0❑El EJ El ❑ El L-1 ❑ ❑ <br /> ❑ El El ❑ 0 El El El <br /> 00 El ❑ El <br /> ❑ El El <br /> ❑ ❑ <br /> El ❑ ❑ ElEl ❑ ❑ ❑ <br /> ❑ ❑ F-1 ElF-1 <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <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 /> Date: 07/11/2006 <br /> Technician's Signature: i <br /> J <br />