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SWRCB,January 2002 Page 1. <br /> ' Secondap Containment Testing Repo Form <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the <br /> appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and <br /> printouts from tests(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> FacilityName: CONOCO PHILLIPS #2708671 1 DateofTesting: 10/18/2007 <br /> Facility Address: 8606 THORNTON ROAD STOCKTON, CA, 95209 <br /> Facility Contact: MANAGER Phone: (2 0 9) 478-8959 <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: TANKNOLOGY, INC. <br /> Technician Conducting Test: GREGORY MCHALE <br /> Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type: A I License Number: 743160 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> TANKNOLOGY ALL 10/03/2009 <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repair <br /> Component Pass Fail Tested Made Component Pass Fail Tested Made <br /> Tank Annular 2 PLU ❑ —1 ❑ 1:1 El <br /> Tank Annular 1 PRE <br /> El ❑ ❑ El El El <br /> Tank Annular 3 UNL ❑ ❑X ❑ El El El El <br /> El- <br /> Secondary Pipe 1 PRE ❑ ❑ ❑ El El El <br /> El- <br /> Piping Sump 1 PRE ❑ ❑ El El El El <br /> El F-1 El El El D <br /> El F1 El El El El El <br /> El 1:1 El El El El <br /> El El El El El El El El <br /> El El El El E-1 El El El <br /> El El El ED E El <br /> El- <br /> El F-1 1:1 El <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> TAKEN <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: Yrriry-rr t �� Date: 10/18/2007 <br />