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a6frTl FR -RYAN INC. <br />SWRCB, January 2002 <br />GR Job # 20-643211 <br />Page I of 2 <br />Secondary Containment Testing Report 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 complete form, written test procedures, and <br />printouts from tests rif applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />I. FACILITV INVnRINATInN <br />FacilityName: Dart Container Corp. Date of Testing: 12/20/2016 <br />Facility Address: 1400 E. Victor Rond <br />Facility Contact Robert Vargas Phone: 209-333-8088 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing) : <br />2. TESTING CONTRACTOR INFORMATION <br />Com im Name: Gettler-Ryan Inc. 6805 Sierra Court Suite G, Dublin, Ca. 94568 Ph.9 925-5.51-7555 <br />Technician Conducting Test: Elodio Sanchez <br />Credentials: CSLB Licensed Contractor <br />k <br />Licenser e: C57 B C6 1/D40 HAZ.A C10 <br />License Number 220793 <br />Manufacturer <br />Manufacturer Trainine <br />Component(s) i 3 2017 <br />Incon Test System Operation <br />Hydrostatic "Testing <br />Phil-Tite <br />Spill Containment <br />Opw <br />Spill Containment� -.- <br />ICC Technician <br />UST Components -` ' <br />3. SUMMARY OF TEST RESULTS <br />�LZM Components IMM <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTFICATION 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: e'--- Date: 12/20/2016 <br />