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SWRCB,January 2002 N./ Page 1 of 8 <br /> Secondary Containment Testing Report Form— FINAL DRAFT <br /> Is Ir.tcnded f:v are by cuntracwrr perf it raing periodic levfing of(AT.sernndary 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 /> prinioutsfrom tests(ifapplicable),should be provided to the facility owner/operatorfor submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: VDate of Testing: 11 /22/02 <br /> Facility Address: 930 E- Victor Rd , T,ndi F CA 9 206 <br /> Facility Contact: Phone: 209-948-9412 <br /> Date Local Agency Was Notified of Testing: 10/8/02 <br /> Name of Local Agency Inspector(if present during testing): RaV Van Flue <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Oil Equipment Service _ <br /> Technician Conducting Test: James P Hesketh <br /> Credentials: K CSLB Licensed Contractor U SWRCB Licensed Tank Tester <br /> License Type:A Ha C 6 1 D 4 0 C10 C 5 7 License Number: 323417 <br /> Manufacturer Traloine <br /> Manufacturer Com onent s Date Training Expires <br /> Modern Welding T nk rlinlnil <br /> Pipe S"mna 6119 /04 <br /> Ameron Pipe 1 /11 /04 <br /> Bravo / <br /> EMCO Fil S ill Tubs N/A <br /> 3. SUMMARY OF T ST SULTS <br /> Not Repairs, Not lilt Component Pass Fail Tested Made Component Pass Feil Tested Made <br /> R2_919uppr Annular L* u U U U u u <br /> Reg Pipe Sump Lk U T U U U U U <br /> Super Pipe Sump U U U U U U U <br /> Reg Second Pipe U 11C U -i U U U U <br /> S U U u U U u u <br /> Disn 1 &2 n U u U u u U U <br /> i 3&4 an u U u u u u U <br /> U u u u u u u <br /> U U U u u u u <br /> u U U u u u u u <br /> U U u u U U u u <br /> u u Iu U u U U u <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Tpqt medium pumped ` act `o tank on tpst trail r <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge, the facts stated in this document are accurnm and In fit(compliance with legal requirements <br /> Technician's Signature: � Date: 1 1 /22/02 <br /> tf mes P. Hesketh <br />