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Page _ of _ <br />SWRCB, January 2002 g <br />Secondary nl e t Testing Report <br />This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the <br />appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACIULITY INFORMATION <br />Facility Name: SINCL Date of Testing: 312/2015 <br />Facility Address: 1001 E. YOSEMITE, MANTECA <br />Facility Contact: NARINDER ne: 209-824-3898 <br />Date Local Agency Was Notified of Testing: 2/27/2015 <br />Name of Local Agency Inspector (tf present during testing): <br />t 111 Y <br />Component <br />®� 1 �: I `.1. ■ Component <br />MOM <br />MOM <br />gn <br />00 <br />11 <br />►'-� O� <br />�0� <br />1' . <br />►+ OQt <br />Qi <br />mom= <br />MIM <br />00 <br />00 <br />0■ <br />If hydrostatic performed,, .. what was .._ with the water after .m,_,., f tests: <br />ALL TEST FLUID SUPPLIED AND RECOVERED BY KAISER COMMERCIALPETROLEUM <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING TBIS TEST-T1r---- <br />/`7 lf. I 1, i /::: lir f4fleomvRa-rcer.I '! <br />uirements <br />Technician's Signature: X4 (V Date: "' �� <br />