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,r <br /> pac:ific Bell <br /> Environmental Management P.O.Box 5095 <br /> Room 3E000 <br /> San Ramon,CA 94583 <br /> Secondary Containment Testing Report Form <br /> 1. FACILITY INFORMATION <br /> Facility Name: Pacific Bell Date of Testing: 8/28/03 <br /> Facility Address: 10 E. 12TH STREET,TRACY <br /> Facility Contact: KEN MCDONALD Phone: 209-473-5430 <br /> Date Local Agency Was Notified of Testing: 48 HOURS PRIOR(AT LEAST) <br /> Name of Local Agency Inspector Present: SAN JOAQUIN COUNTY ENV HEALTH—STEVE SHIN <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Tait Environmental Systems <br /> Technician Conducting Test: Robert Allen <br /> Credentials: ® CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester <br /> License Type and#: A,B,CIO,HAZ 588098 <br /> Training by Manufacturer <br /> Manufacturer Component(s) Date Training Expires <br /> Supplied Upon Request <br /> 3. SUMMARY OF TEST RESULTS <br /> Number of Tanks Tested: 1 Number of Piping Runs Tested: 1 <br /> Number of Submersible Pump Sumps Tested: 1 Number of UDC Boxes Tested: 0 <br /> Number of Fill Sumps Tested: I Number of Overfill Boxes Tested: 0 <br /> Component Pass Fail Comments <br /> ANNULAR <br /> FILL SUMP 19 <br /> PIPING SUMP <br /> SUPPLY SECONDARY ❑ <br /> RETURN SECONDARY ❑ <br /> ❑ <br /> *All pressure testing must utilize an inert gas. <br /> d_,2 19 <br /> Technician's Signature: <br /> Date: D <br /> R.C.U.S.T.COM <br />