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+ 2560 So uel Avenue Ste 2 C <br /> qTF*1EC����EDSanta Cruz CA 95062 T: 831.475.8141 _ AUG 2 5 2006 <br /> F: 831.475.8249 <br /> CA Lic#693807 A-HAZ B-14IC ENVIRONMENT HEALTH <br /> PERMIT/SERVICES <br /> Secondary Containment Testing Report Form <br /> 1. Facility Information <br /> Facility Name: Valero 3492 Date of Testing: 7/10/2006 <br /> Facility Address: 470 North Main Street,Manteca CA.95336 <br /> Facility Contact: Phone: 209.823-1344 <br /> Date Local Agency Was Notified of Testing: 07/06/2006 <br /> Name of Local Agency Inspector(if present during testing): <br /> 2. Testing Contractor Information <br /> Manufacturer Component Expiration Date <br /> Incon Leak Detector 11/23/07 <br /> 3. Surnmary of Test Results <br /> Component P F NT RM Component P F NTRM <br /> Spill Buckets:All © ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑! <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑. ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <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: 7/12/2006 <br /> Technician's Name: Frank Bohnet <br /> :.7�77 E-MAILED <br /> ;CANNED <br /> Iof2 <br />