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Apr 18 03 06: 48p Fr -ten Hill 559E 1467 p• 9 <br /> SWRCB,January 2002 Page I of 7 <br /> Express Manteca <br /> Secondary Containment Testing Report Form C'r-�4e <br /> This form is intended for use by contractors performingperiodic testing of USTseconderry contci.nment s'Yv erns. Use the <br /> appropriate pages of this form to report results for all components tested. The completed form, written testprocedures, and <br /> printouts from tests(if applicable),should be provided to the facility owner/operator for submiral to the local regulatory agency. J <br /> 1. FACILITY INFORMATION <br /> Facility Name: BOYETT EXPRESS I Date of Testing: 3-19-03 _ <br /> Facility Address: 419 S.MAIN MANTECA CA, WO#0303CJ _-- Time: _ <br /> Facility Contact: MONICA Phone: — <br /> Date Local Agency Was Notified of Testing: ---- <br /> Name of Local Agency Inspector(tfpresent during testing: tee® <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Franzen-Hill Corp 1100 North J Street Tulare,CA 93274 <br /> Technician Conducting Test: FELIX MENDES _— _--— <br /> Credentials: x CSLB Licensed Contractor S WRCB Licensed Tank Tesv,,r <br /> License Type: A.,13,C-61/D40 HAZ License Number. 3041_47 <br /> -Manufacturer Training <br /> tu777 Co.. onent s Date Trainn_pExpires <br /> FEnviro7m Pi in and Testin 10 03 <br /> otal Containment Piping and Testing — _ 10/33 __-__ <br /> rIncon Testm adwelll Testing <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Re airsNot Repairs <br /> Component Pass Fail Tested Made <br /> — Pass Fail Test--dMade <br /> UDC 1-2 X -- �— <br /> UDC 3-4 X <br /> If hydrostatic testing was performed,describe what was done with the water after completion c:'test5: <br /> PUMPED 15 GALS OF CLEAN WATER BACK ON TO THE TRUCK. <br /> CERTIFICATION OF TECHPIICLkN RESPONSIBLE FOR CONDUCTING TRIS TESTING <br /> To the best of my knowledge,the facts stated in this document are accurate and in full coinpfiance with legal requirements <br /> Technician's Signature:—FELIX MENDES Date:3-19-03___ ___ <br />