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SWRCB, Januery2002 Page�_of <br /> Secondary Containment Testing Report Form <br /> This form is intendedfor use by contractors performingperiodic 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 procedlres,and <br /> printouts from tests ff applicable),should be provided to the facility ownerAperator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: BP W est Coast Products,LLC 7D ate of Testing: <br /> Facility Address: 1250N WILSON WAY City: STOCKTON Zip: 95202 <br /> Facility Contact: I Phone: S-�5 S <br /> Date Local Agency Was Notified of Testing: <br /> Name of Local Agency Inspector(u'presentduri testing): 5LW6- SH/ <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Compare Name: TAIT ENVIRONMENTAL SYSTEMS <br /> TechnicianConductin Test: ^c` <br /> Credentials: SLB Licensed Contractor ❑SWRCB Licensed Tank Tester <br /> License Type: A ASB HAZB CAB 10 License Number: 588098 <br /> Manufacturer Traitdne <br /> Manufacttue Component(s) DateTrairvn E ices <br /> 3. SUAEVIARY OF TEST RESULTS <br /> Component PusFail °i ��s Component pus Fan of airs <br /> Tested Made Tested Made <br /> d ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Oe 1 ❑ 1 ❑ 1 ❑ ❑ ❑ ❑ ❑ <br /> 0' ❑ 1 ❑ 1 ❑ ❑ 1 ❑ ❑ 1 0 <br /> V-1 ❑ 1 ❑ 1 ❑ 0 ❑ 0 0 <br /> ❑ 1 ❑ 1 ❑ ❑ 0 ❑ 1 0 ❑ <br /> ❑ 1 0 1 ❑ ❑ 0 ❑ 1 0 ❑ <br /> 0 ❑ ❑ 0 ❑ ❑ ❑ 0 <br /> 0 0 0 ❑ ❑ 0 0 ❑ <br /> 0 ❑ ❑ 0 0 0 0 0 <br /> ❑ 0 ❑ ❑ ❑ ❑ ❑ 0 <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> rriJ 4Q CtkkA <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the bast of my knowledge,the ffaaetssta�ted in this document are accurate and ix fill compliance with legal regairowaxts <br /> Technician's Signatures - Dater <br />