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RECEIVED <br /> NOV 13 2017 <br /> Secondary Containment Testmig Report Form <br /> ENVIRONMENTAL HEALTH <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systeZ A .T <br /> 0 enures, nyENT <br /> appropriate pages of this form to report results for all components tested. The completed form,written test pro a <br /> printouts from tests(if applicable),should be provided to the facility ownerloperatorfor submittal to the local regulatory agency. <br /> z. FACILITY INFORMATION <br /> Facility Name: Unocal#255886 Date of Testing: 10102/17 <br /> Facility Address: 2701 West March Lane,Stockton CA 95219 <br /> Facility Contact: Phone (209)473-7337 0 Initial 0 Repair Test <br /> Date Local Agency Was Notified of Testing: 09/25/17 El 6 Month 00ther <br /> Name of Local Agency Inspector(if present during testing}: Aaron Hang 0 Triennial <br /> TEST G CONTRACTOR-WjF0PJqAT10N <br /> Company Name: ABLE Maintenance,Inc, <br /> Technician Conducting Test: Eric Salinger I I.C.C.#8729426 <br /> Credentials: 0 CSLB Licensed Contractor 0 SWRCB Licensed Tank Tester f 0 ICC UST Service Technician <br /> License Type; A,8,HAZX10 _.[Rcen!e_�urnber:3129" <br /> —7' - - -17.= - , <br /> ManufftetuMLTraining <br /> Manufacturer <br /> Available upon request <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail <br /> Not <br /> "o, <br /> Test!TNf2de Tested Made <br /> S7 Product Secondary @ 0 <br /> 91 Product Secondary <br /> Diesel Product Secondary I 1 0 17— <br /> Diesel Turbine Sump U I <br /> UDC 7/8 CJ <br /> UDC11/12 <br /> El <br /> 0 <br /> —IU <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Used <br /> Pump"rest Truck <br /> For any equipment capable of generating a print out of test results,you must attach a copy <br /> of the test report to this certification 0 System printout attached. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of OW knowledge,the facts stated In this document are accurate and In full compliance with legal requirements <br /> Technician's Signature: Date: 10/02/17 <br />