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Secondaff Containment• Repot <br />This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the <br />appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and <br />printouts from tests (if - - - ' * ' .1 . wner/operator for submittal to the local regulatory agency. <br />Conoco Phillips #2708671 ,TION <br />Facility Name: 8606 Thornton Rd. ' Date of Testing: $ o <br />Facility Address: Stockton, CA. 95209 <br />N04598 — SB 989 Testing <br />Facility Contact: Phone: <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): NA <br />2. TESTING CONTRACTOR O, <br />Conducting Test: <br />Credentials:Technician <br />0 ontractorSWRCB Licensed Tank Tester <br />License Type: A B ASB C-1 0 HAZ D40 License Number: 300345 <br />Manufacturer n_ <br />Manufacturer •m,• <br />Date Training Expires <br />SU PPLI Ellu Ai#,N-A-E-*U EST <br />SUMMARY3. RESULTS <br />IMMM <br />OF070 <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 />10-� <br />Technician's Signature: _ __® Date: <br />