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IDLJ�l SWRCB, January 2002 Page of �_ Secondary Containment Testing Reportorm Thisform is intended or use b contractors performing periodic testingo UST secondzii�� '''`�irm` ��'Wlt s'. Use the appropriate pages of this form to report results for all components tested. Thecomplete' i�ti�Cefi ies�tit ocedures, and printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. IMIX0 I IIVAM1 M11j6Er L= Facility Name: MANTECA VALERO Date of Testing: 12/01/2008 Facility Address: 1001 E. YOSEMITE Facility Contact: GEORGE Phone: (209) 824-9282 Date Local Agency Was Notified of Testing: 11/24/2008 Name of Local Agency Inspector (f present during testing): Company Name: SST -Service Station Testing Technician Conducting Test: Heath A. McEver Credentials: ❑ CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type: Tank Tester, Technicain License Number: 04-1677 ...., ,.... „ „>.. Manufacturer Training Manufacturer Component(s) Date Training Expires INCON TS STS TESTER 10/13/2010 Fail Not Tested KAWYIh/105".1 17111Y9f. D Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made 91/DSL ANNULAR SPACE X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 87 ANNULAR SPACE X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DISPENSER 1-2 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DISPENSER 3-4 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DISPENSER 5-6 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DISPENSER 7-8 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ ❑ ❑ ❑ ❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after comple on of tests: TRANSPORTED AS TEST FLUID CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts st din this document are accurate and in full compliance with legal requirements Technician's Signature: — Date: ��