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SWRCB, January 2002Page <br />• RECEIVED <br />Secondary Containment Testing Report Form BAR 18 2014 <br />This form is intended for use by contractors performing periodic testing of UST secondary containment <br />pages of this form to report results for all components tested. The completed form, written test pr( cedur, <br />applicable), should be provided to the facility owner/operator for submittal to the local regulatory agenc . <br />1. FACILITY INFORMATION <br />Facility Name: 7 ELEVEN 35355 Date of Testing: 2/27/2014 <br />Facility Address: 3202 W HAMMER LANE , STOCKTON, CA 95209 <br />Facility Contact: MANAGER Phone: 209-957-2900 <br />Date Local Agency Was Notified of Testing: 2/27/2014 <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />Company Name: TANKNOLOGY INC. <br />Technician Conducting Test: Brent Bowen <br />Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester <br />License TVDe: a License Number: 743160 <br />Manufacturer Training <br />Manufacturer <br />Date <br />II opw spill buckets 2/2/2015 1 <br />'A CiTMMARV nF TF.gT R1FgITI,TR <br />Component <br />Pass <br />Fail <br />Not <br />Tested <br />Repairs <br />Made <br />Component <br />Pass <br />Fail <br />Not <br />Tested <br />Repairs <br />Made <br />Spill Box Tl: rul fill <br />X <br />Spill Box T2: pul fill <br />X <br />Spill Box T3: diesel fill <br />X <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />too test water with me <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: Az--Y-Ae— Date: 2/27/2014 <br />WO: 2315745 <br />