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Oct 21 12 04:45p Lower Sacramento Chevron 2099540582 p.2 <br /> SWfW13.January 2002 Page 0._ <br /> Secondary Containment Testing Report Form <br /> Thiv,fisrm i,in±ended for?is,-,by contractors performing periodac resting of Usrsecofadary containment systems. Use the <br /> apflroprfcrlL pages o>rrhis form to repay t results lar all carnpnrtents tcstG'd. The completed forth.written test procedures, and <br /> prirxotats•fi-onr tests(if applicable.), ,should be provided to the facility ownerloperator for submittal to the local regulatory <br /> 1. FACILITY INFORMATION a d_ <br /> aciflty Name: f.owerSacraments,Chevron Date of Testing: <br /> t'acility Address: 8660 Lower Sacramento Road,Stockton Ca 95230 <br /> Facility Cnmet: Kamal Kapoor — Phone: 209-477-2844 <br /> DEof-al'�A;3�c—al <br /> ency Was Notified of Testing: 412V12 -- <br /> NAgency Inspector(tf present during testfng): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: JP Petroleum Service <br /> `ie—chnickin C:onductin�g Test; Gabe Garcia <br /> Cr•edent gals: x CSLS Licensed Contractor I.14WRC.B Licensed Tank Tester _ <br /> Licensc`Type: A License Number: 811471 ICC if 5281582 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Lxpinas <br /> 3. SUMMARY OF TEST RESULTS <br /> t - Not Repairs 'dot Repairs <br /> m <br /> Ccanponesat Pass Fail Tested Made Component Pass I=sit 'EestecE 1l��lc <br /> Annjalr 1 —Super x CJ' El UDC 1-2 0 <br /> An.rralar 2—Plus x ❑ r UDC 3-4 x ❑ <br /> Annular 3 —Regular x � L1 UDC 5-g x C1 e._1 <br /> 1,ine 1 — Super x 0 Li L UDC 7-8 x ❑ l:l <br /> Line 2 —Plus x 0 t l I.-I x 1,1 _'.'......' <br /> Line. 3- Regular x 0 Ll LI <br /> x 0 171 l_i <br /> _.. ,_................._...._._ <br /> SUtltp 1 — Superx [_ <br /> Sump 2--Patsx G 0 [J G +` I:� <br /> i__; S <br /> .G <br /> Slump 3 -Regular x � 7 ❑ I"i ❑ ' <br /> n ❑ f Cl ❑ J D <br /> le. ® ❑ n <br /> it'hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> lkatet eras filtered and returned to holding tank <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the hast of my kttowlerlge,fixe facts stated in this document are accurate orad ttr fsrtl compliance with legal requirernenis <br /> Date_ <br /> Technicians Signature: L' f "7 <br />