Laserfiche WebLink
SWRCB, January 2002 Page 1 of 1 <br />Secondary Containment Testing Report Form <br />This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate <br />pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests <br />(if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1 _ FAC'TT.TTV TNFnRMATTCIN <br />Facility Name: 7 ELEVEN 35355 Date of Testing: 2/23/2012 <br />Facility Address: 3202 W HAMMER LANE , STOCKTON, CA 95209 <br />Facility Contact: MANAGER Phone: 957-2900 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): GARRET <br />I� ■ �II.711\[�i�lU\� �:r Lel l�Ja IU ��JT�1'L�;�i��\ <br />Company Name: TANKNOLOGY INC. <br />Technician Conducting Test: Steven Willems <br />Credentials: ry CSLB Licensed Contractor r SWRCB Licensed Tank Tester <br />License Tv -De: ICC ILicense Number: 8016974 <br />Manufacturer Trainine <br />Manufacturer Component(s) Date Training Expires <br />TANKNOLOGY ALL 11/18/2013 <br />3. SUMMARV OF TEST RF.STIT.TC <br />Component <br />i <br />FIN <br />'Spill Box T2: PUL F <br />Spill Box T3: Diesel F <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: TAKEN IN WATER TRAILER <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the11 facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: e W ` Date: 2/23/2012 <br />