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RhCE V <br /> SWRCB,January 2002 • age/of <br /> FEB 205 200 <br /> Secondary Containment Testing Report F r <br /> ENVVRIEN1 HEALTH <br /> This form is intended for use by contractors performing periodic testing of UST secondary contp* r�geCe the <br /> appropriate pages of this form to report results for all components tested. The completec4 form, written test procedures, and <br /> printouts from tests(f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: VALERO I Date of Testing: 1/26/2009 <br /> Facility Address: 1001 YOSEMITE AVE,MANTECA,CA 95336 <br /> Facility Contact: KASEEM Phone: (209)824-9282 <br /> Date Local Agency Was Notified of Testing: 1/21/2009 <br /> Name of Local Agency Inspector(fpresent during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: SST-Service Station Testing <br /> Technician Conducting Test: Heath A.McEver <br /> Credentials: ❑CSLB Licensed Contractor )LSWRCB Licensed Tank Tester <br /> License Type: Tank Tester,Technicain License Number: 04-1677 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> INCON TS STS 10-13-2010 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> 87 STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 91 STP SUMP ❑ X ❑ ❑ ❑ ❑ ❑ ❑ <br /> DSL STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 87 SECONDARY LINE X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 91 SECONDARY LINE ❑ X ❑ ❑ ❑ ❑ ❑ ❑ <br /> DSL SECONDARY LINE X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ ❑ -9—ji ❑ ❑ ❑ ❑ <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 facts st in this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: "� Date:—"�,4:: , <br />