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SWRCB, January 2002 Page, of <br /> Secondary Containment Testing Report Form <br /> This form is intended,#or use by contracforsperformingperiodic felting of UST secondary containment systems. Use the <br /> appropriate pages ofthisform to report results for all components tested. The compietedform, written testproee&res,and <br /> printoltsfrom tests('applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION SS#: 6020 <br /> Facility Name: BP West Coast Products,LLC Date of Testing: <br /> Facility Address: 1711 E YOSEMITE City: MANTECA Zip: 95336 <br /> Facility Contact: 711A ,7h Ti I Phone: 53 0--G 6 6 3 C�- <br /> Date Local Agency Was Notified ofTesting: HIL5 pr,vo- <br /> Name of Local Agency Inspector(Vpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: TAIT ENVIRONMENTAL.SYSTEMS <br /> TechnicianConduc+ting Test: <br /> Credentials: $CSLB Licensed Contractor ❑SWRCB Lic ens e d T ank T ester <br /> License Type: A ASB HAZB CI O License Number. 588098 <br /> Many fsc tuner Trafnint <br /> Manufacturer Compenent(s) Date Training Expires <br /> 3. S'UNIlVIARY OF TEST RESULTS <br /> Component PAY Fail Tested Made Comq�onent Pus Fail Not <br /> Tested hl,fie <br /> 5 ��, lG>7� ✓ �yY 7 ❑ ❑ ❑ _ ❑ ❑ ❑ ❑ <br /> -f L9F ❑ ❑ 0 0 ❑ 0 ❑ <br /> ❑ 0 ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> S 1 ❑ ❑ ❑ ❑ ❑ a ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> a❑ ❑ ❑ ❑ ❑ 11 ❑ <br /> ❑ ❑ ❑ o ❑ 11 11 [1❑ ❑ 11110 ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ 04 <br /> ❑ ❑ <br /> If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the factsstated in this document are accurate and in fatll compliance with regal requiramants <br /> 7 <br /> Technician's Signature: Dater ct— <br />