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S WRCR,January 2002 <br /> MAR 0Page Page 1 of 7 <br /> Secondary Containment Testin&j�'Pjjj ICES fi <br /> Stockton Service Station Equipment Co., Inc. <br /> 808 N. Union Street, Stockton, CA 95205-4152 (209)464-8333 FAX (209)464-8349 <br /> California Contractor License 309105 A-C61/D40 HAZ/HIC E-mail sssecoCmpacbel 1.net <br /> 1. FACILITY INFORMATION <br /> Facility Name: Gas 4 Less Date of Testing March 4,2010 _ <br /> Facility Address: 3434 Manthey Road,Stockton,CA 95206 <br /> Facility Contact: Gilbert Silva Phone: 209.992.7620 <br /> Date Local Agency Was Notified of Testing: March 1,2010 <br /> Name of Local Agency Inspector(if present during testing) Michele Henry <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Stockton Service Station Equipment Co.,Inc. _ <br /> Technician Conducting fest: Randy Chidwiek <br /> Credentials: [X I CSLB Licensed Contractor [ ] SWRCB Licensed Tank Tester <br /> License Type: C-61/1340 HAZ/HIC License Number: 309105 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> 'rested Made __ Tested Made <br /> Tani:Annular, Page 2 � X X <br /> Secondary Piping,Page 3 X X __— <br /> Under Dispenser Containment Pg.5 X X _ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> PAGES 4, 6, 7 N/A <br /> CERTIFICATION 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: R,G nd1Chadwick Date: March 4,2010 <br />