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age: 1 of: 7 <br /> Ad <br /> Franzen-Hill <br /> Construction, Maintenance&Testing for Fueling Facilities i&Lubricating Systems <br /> Secondary Containment Testing Report Form <br /> 1. FACILITY INFORMATION <br /> Facility Name: Date of Testing: —Z <br /> Facility Address: <br /> Facility Contact: Phone: <br /> Date Local Agency Was Notified of Testing: 11 Job#: <br /> Name of Local Agency Inspector Present: <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Franzen-Hill Corp. Tular Ca. <br /> Technician Conducting Test: �icense�an �este <br /> Credentials: ✓ CSLB Licensed ContraVor �o <br /> License Type and#: A,B, C-61ID40 HAZ Lic#304147 <br /> Training by Manufacturer <br /> Manufacturer <br /> Component's) Date Training Expires <br /> ILEnviron,APT Piping and Testing <br /> Smith Fiberglass, EBW Piping and Testing <br /> Total Containment,VeederRoot Piping and Testing <br /> Econ,Gilbarco EMC, Monitor System Piping and Testing <br /> 3. SUMMARY OF TEST RESULTS <br /> Number of Tanks Tested: Number of Piping Runs Tested: .. <br /> Number of UDC Boxes Tested: <br /> Number of Submersible Pump Sumps Tested: Number of Overfill Boxes Tested: <br /> N 12 <br /> umber of Fill Sumps Tested: - <br /> Comments <br /> Component Pass Fail <br /> El <br /> ❑ <br /> El <br /> El <br /> ❑ ❑ <br /> ❑ ❑ <br /> Date: <br /> Technician's Signature: <br /> 1100 North J Street,Tulare,Ca.93274-1939 PH. 559-688-2977 FAX 559-688-1467 <br /> 2080 South Union Ave, Bakersfield,Ca.93307-4154 PH.661-834-1100 FAX 661-834-4216 <br /> www.franzen-hill.com <br /> SWRCB <br />