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' RECEIVED <br /> JAN 3 0 2015 <br /> Secondary Containment Testing Report For NVIRONMENTAL <br /> This form is intendedfor use by contractors performing periodic testing of UST secondary containment s'AP*P;j4 AA;:NT <br /> appropriate pages of this form to report results for all components tested. The completedform, written test procedures, and <br /> printouts from tests(ifapplicable),should be provided to the futility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ARCH ARCO I Date of Testing: 12/3/2014 <br /> Facility Address: 4855 S HWY 99,STOCKTON County SAN JOAQUIN <br /> Facility Contact: GILL Phone: 209-481-7448 <br /> Date Local Agency Was Notified of Testing: Wednesday,November 05,2014 <br /> Name of Local Agency Inspector(If present during testing): NONE <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: B.Z.Service Station Maintenance <br /> Technician Conducting Test: TIM BURKART <br /> Credentials: ®CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester <br /> License Type: ICC License Number:433159 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> INCON TS-STS 8/1/2016 <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repairs <br /> Component Pass Fail Tested Made Component Pass Fail Tested Made <br /> UDC 1/2 UDC 3/4 <br /> UDC 5/6 UDC 7/8 <br /> UDC9/10UDC 11/12 ® ❑ ❑ ❑ <br /> UDC 13/14 UDC 15/16 <br /> UDC 17/18 ❑ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> TOOK AS TEST WATER <br /> SB989 TEST IS NOW COMPLETE, OTHER COMPONANTS TESTED ON 11/3/14 <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,thefacts ted in this document are accurate and in full compliance with legal requirements <br /> Technician's Signattire: 4_ ,tice. L —�� Date: 12/3/2014 <br /> Secondary Containment Test Results I of 4 <br />