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SWRCB, January 2002 Page 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 <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 applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: CONOCO PHILLIPS #255886 <br />DateofTesting: 04/27/2007 <br />Facility Address: 2701 W MARCH LANE STOCKTON, CA, 95207 <br />Facility Contact: MANAGER <br />Phone: (2 0 9) 473-7337 <br />Date Local Agency Was Notified of Testing: <br />Name of Local Agency Inspector (if present during testing): <br />INFORMATION2. TESTING CONTRACTOR <br />Company Name: TANKNOLOGY, INC. <br />Technician Conducting Test: DOUG FALDE <br />Credentials: <br />Box I REG FILL <br />CSLB Licensed Contractor <br />SWRCB Licensed Tank Tester <br />License Type. <br />Manufacturer <br />License Number: <br />Manufacturer Training <br />Component(s) <br />Date Training Expires <br />Spill Box 1 REG VAPOR <br />Spill Box 2 SUP FILLISpill <br />0�■ <br />00 <br />��00 <br />K W-11jonirn-mcf]aI*--IanYi>fr <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//fac`t��s stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: ' J. —7:;2— �' <br />-- Date: 04/27/2007 <br />Box I REG FILL <br />Spill Box 1 REG VAPOR <br />Spill Box 2 SUP FILLISpill <br />0�■ <br />00 <br />��00 <br />Box 2 SUP VAPOR <br />';Spill Box 3 DIE FILL <br />0■ <br />0 <br />■00 <br />�■ <br />�ODI�i <br />000; <br />�■ <br />�■ <br />0� <br />����0■ <br />0■ <br />00 <br />�� <br />■00' <br />0■ <br />� <br />■00'i <br />�■ <br />�■ <br />00 <br />0■ <br />0 <br />■00 <br />�■ <br />�■ <br />■00■ <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//fac`t��s stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: ' J. —7:;2— �' <br />-- Date: 04/27/2007 <br />