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condary Containment Testing Forms <br />Site Test Log Form <br />Testing Contractor: Able Maintenance <br />UST Service Technician I.C.C.# 5254517 -UT <br />Under Dispenser Containment <br />Site #: Safeway #2600 (3yr. Compliance Test) <br />Address: 1804 W. 11th Street <br />City: Tracy, CA 95376 <br />Technician: James Moore Date: 1/11/06 <br />Under Dispenser (#) <br />Description (Manufacturer, Specs) <br />Condition (Repair Notes) <br />1. 1 &2 <br />2. 3&4 <br />WESTERN FIBERGLASS <br />WESTERN FIBERGLASS <br />Test Time (HH:MM) <br />Start / Finish <br />Test Results <br />Pass / Fail <br />Test Notes <br />1. 3:27 - 3:39PM <br />PASS <br />Start Level: 10.58990 <br />End Level: 10.58990 <br />2. 3:27 - 3:39PM <br />PASS <br />Start Level: 10.70415 <br />End Level: 10.70449 <br />Under Dispenser (#) <br />Description (Manufacturer, Specs) <br />Condition (Repair Notes) <br />1. 5&6 <br />2. 7&8 <br />WESTERN FIBERGLASS <br />WESTERN FIBERGLASS <br />Test Time (HH:MM) <br />Start/ Finish <br />Test Results <br />Pass / Fail <br />Test Notes <br />1. 3:28 - 3:40PM <br />PASS <br />Start Level: 9.74195 <br />End Level: 9.74166 <br />2. 3:28 - 3:40PM <br />PASS <br />Start Level: 10.99888 <br />End Level: 10.99852 <br />Page 1 of 2 1804 W. 11th St - 301620 - 3yr..x1s Dispenser Containment <br />