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r <br />�"*....+' P�ac ft[ Bets <br />Environmental Management P.O. Box 5095 <br />Room 3E000 <br />San Ramon, CA 94583 <br />Secondary Containment Testing Report Form <br />ICA OTT ITV TTV n7DM AT7(1N <br />Facility Name: Pacific Bell a _ - <br />Date of Testing: 8/28/03 <br />Facility Address: 10 E. 12TH STREET, TRACY <br />Number of Submersible Pump <br />Facility Contact: KEN MCDONALD <br />Phone: 209473-5430 <br />Date Local Agency Was Notified of Testing: <br />48 HOURS PRIOR (AT LEAST) <br />Name of Local Agency Inspector Present: <br />SAN JOAQUIN COUNTY ENV HEALTH - STEVE SHIN <br />17 TFQTTNC`_ 4-ONTRACTOR INFORMATION <br />CTTi%/F"m.4 A 1DV d -%w TTi QT 12Ti QTTT TQ <br />Number of Tanks Tested: <br />.. la. 8 <br />- Number of Piping Runs Tested: 1 <br />Number of Submersible Pump <br />Sumps Tested: 1 <br />Number of UDC Boxes Tested: 0 <br />Number of Fill Sums Tested: <br />Com onent <br />1 <br />Pass Fail <br />Number of Overfill Boxes Tested: 0 <br />Comments <br />ANNULAR <br />FILL SUMP <br />PIPING SUMP <br />SUPPLY SECONDARY <br />RETURN SECONDARY <br />*All pressure testing must utilize an inert gas. <br />Technician's Signature: Date: a a 3 <br />R.C.U.S.T.COM <br />-1 <br />