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NAL1,11 <br />Pa(ye I of 2 <br />Spill Containment Testing <br />1. FACILITY INFORMATION <br />Facility Name: Ryder Truck Rental 1071A Date of 1i8/2016 <br />Facility Address: 3633 Duck Creek Road, Stockton, CA 95215 <br />Facility Contact: James Shannon Phone: (209) 943-3213 <br />Date Local Agency Was Notified of Testing: 12/4/2015 <br />Name of Local Agency Inspector (if present during testing): Stacy Rivera <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: <br />Balch Petroleum Contractors & Builders, Inc. <br />Technician Conducting Test: Robert Henninger <br />Credentials: <br />X CSLB Licensed Contractor :' SWRCB Licensed Tank Tester <br />License Type: <br />A / B / C-10 / HAZ License Number: 396575 <br />Manufacturer Trainine <br />Manufacturer Component(s) Date Training Expires <br />Ronan <br />Hydrostatic Sump Tester NA <br />Caldwell <br />Hydrostatic Sump Tester NA <br />X L <br />_; <br />T3 –New Oil Bucket <br />Notes: <br />Testing water is recycled. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge the acts st ted in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: Date: 1/8/2016 <br />J. SUMMARY OF TEST <br />RESULTS <br />Component <br />Pass Fail Not <br />Tested <br />Repairs <br />Made <br />Component Pass Fail Not Repairs <br />Tested Made <br />T1 - Diesel Bucket <br />X <br />X <br />T2 – Reserve Diesel Bucket <br />X L <br />_; <br />T3 –New Oil Bucket <br />X <br />X <br />T4 –Waste OiI Bucket <br />X L, <br />X <br />— <br />Ll <br />- <br />1 <br />Notes: <br />Testing water is recycled. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge the acts st ted in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: Date: 1/8/2016 <br />