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' FROM SIDHU GURP PHONE NO. : 209 474 320 Nov. 13 2006 12:50PM P1 <br /> SWRCR,January 201)2 <br /> Page 1 of 7 <br /> Secondary Containment Vesting Report Farm <br /> Stockton Service Station l--quipm.ent Co., Inc. <br /> 908 N. Union Street, Stockton, Cts. 95205-4152 (209) 464-8333 FAX (209)464-8349 <br /> California Contractor License:309105 A-(:61/r)40 HAM41C F-inHil sssc;co(!i)nacbell.ne-t <br /> 1. FACILITY INFORMATION _ <br /> Facility Narnc WATERLOO FO011& Furl ate Dof Testin : May 31,2005 <br /> Facility Address:3032 E.Waterloo Road,Stockton,CA 95205 <br /> Facility Contact: Paul Phone: 209.466.5816 <br /> Date Local Agency Was Notified of Testing: .May 24,2005 <br /> Name of Local Agency Ins ector(jDrresent during testing) <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Ny ame, Stockton Service Station Equipment Co.,Inc. <br /> Technician Conducting Test: Randy Chadwick <br /> Credentials-__,IX I CSLB Licensed Contractor � � ] SWRCB Licensed Tank Tester <br /> License Type, C-61/D40 HAZ/HIC License Number' 309105 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> 1IST INSTALLA,1ION/Itl'1'1201+UTING Certification Number`{X4141014428March 11,2007 <br /> --3.-SUMMARYOF TEST RESULTS <br /> Component Pass Fail Not Repairs componentPass Fail Not Repairs <br /> _ Tested Made Tcsted Made <br /> Tank Annular Test X <br /> Secondary Pipe #3&4 X _.. ,.,...... <br /> Secondary Pic #S&f, x R uW-Unleaded <br /> Pi iu $urn a'lest __ X <br /> UCD Test 1&2,3&4 X <br /> UCD 5&6 NOT TESTED X R ular-Lhafeaded <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> (Pages 61 N/A) <br /> THREE(3)DRUMS OF TEST WATER LEFT ON SITE.FOR Cl RTI F t1 1)TANK HALILER TO DISPOSE OF. <br /> CERTIFICATION OF TF.,CHN1r1AN RFSFONSiRI,,F,FOR CONDUM. NG THIS TESTING <br /> To the best of try knowledge,the facts stated in this document are acciirate and an f«ll conxpliance with legal requirements. <br /> Technician's Signature: Ra.rl.dU Chadwick ?Date. May 31,2005 <br /> Russell Chadwick <br /> MAILED TO: San Joaquin Co. Environmental health District <br />