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Page Secondary Containment Testing Report Form or� This forst is intended for use by contractors petfonning periodic testing of UST secondary containment sy4tf,rJ�r; Use the? 2005 appropriate pages of this form to report results for all components tested. The completed form, written test P,1,1 res, and printouts from tests (if applica verator for submittal to the loc'at ldptory agency., BP Arco # 05469 Facility Name: Facility Address: Facility Contact: 130 S. Wilson Way Stockton, CA 95205 N05245R-SB 989 Repair Date of Testing: Phone: Date Local Agency Was Notified of Testing : 1 IName of Local Agency Inspector (if present during testing): NA 2. TESTING CONTRACTOR INFORMATION Company Name: Wayne Perry Inc. Pass Technician Conducting Test: ,,v / ,44,q - Credentials: ® CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type: A B ASB C-10 HAZ D40 Manufacturer License Number: 300345 Manufacturer Training Component(s) Date Training Expires SUPPLIED UPON REQUEST s T-7 R' E:3 ❑ ❑ ❑ 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made s T-7 R' E:3 ❑ ❑ ❑ ❑ ❑ ❑ - N ❑ ❑ ❑ ❑ ❑ ❑ ❑ 9� ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ N f -lc, ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ I ❑ I P_L ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: J /� Date: