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02/28/2012 13:40 0000000 0 `@@�������� PAGE 02/06 <br /> Secondary Containment Testing Report Fo�CEIVED <br /> For use by Unidocs Member Agmeles or where approved by your Local Jurisdiction <br /> Authority cited., Heath and Safety Code§75293;77de 23 CCR§2437(a)(4) FEB 2 8 2012 <br /> ONMENTALHEALTH <br /> This form, or the standard form develped by the State Water Resources Control Board (S)AMR191"9MCK4 <br /> by contractors performing periodic testing of underground storage tank (UST) secondary containment systems <br /> in Unidocs member agency jurisdictions. The completed form, written test procedures, data collection logs, and <br /> printouts from test equipment (if applicable), must be provided to the facility owner/operator for submittal to <br /> the local regulatory agency within 30 days of the test date. <br /> SWRCB requires that the entire volume of each sump and under-dispenser containment(UDC) system be tested <br /> if the sump/UDC is not equipped with a continuous monitoring system that shuts down the pump when a leak is <br /> detecetd or the leak detection sensor fails or is disconnected. (see swaco Low Guidance Letter LG-1603 <br /> Systems where leak detection equipment continuously monitors both primary and secondary containment (e.g. <br /> systems that are hydrostatically monitored or under constant vacuum) are exempt from periodic testing <br /> requirements. p3 CCR p203riawn <br /> In the case of pressure/vacuum testing, M loss in pressure/vacuum during the course of the test shall be <br /> considered a failed teat,regardless of the manufacturer's criteria for declaring a passed test. (23 CCR p2Q7(a)(2)3 <br /> A. Facility Information <br /> Facility Name: valley Pacific Petroleum Services Date of Testing; January 11,2012 <br /> Site Address: 3550 S. Hi hwa 99,Stockton CA <br /> Facility Contact: Mikc Elisson Phone: 800-266-3782 <br /> Date Local Agenc was Notified of Testing: 1.-3-1.2 <br /> Name of Local Agency Inspector(rfpresent during testing): <br /> B. Testing Contractor Information <br /> Company Name: Kern Coun Construction Inc. <br /> Credentials: ®CSLB-Licensed Contractor; ❑ SWRCB-Liccnsed Tank Tester <br /> License Type: M A; ❑C-10;❑C-34; ❑C-36;❑ C-61 (D40) License Number: 481053 <br /> Name of Technician Conducting Tests: Josh Simmons <br /> Training by Equipment Manufacturer <br /> Manufacturer Component(s) Date Training Expires <br /> Incon TS-STS 12-2-12 <br /> C. Certification by Technician Responsible for Conducting Testing <br /> To the best of my knowledge,the facts stated in this document are accurate and in full compliance with <br /> legal requirements. <br /> Technician's Signature: , Date: <br /> UN-054-1/$ wwwemidncp.arfi 02/26/02 <br />