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SWRCR,January 2002 <br /> f7 I of 7 <br /> L <br /> Secondary Containment Testing Report Form <br /> .OLIN - <br /> )� <br /> , 8 2006 <br /> Stockton Service Station Equipment Co., Inc. HEALTH <br /> 808 N. Union Street, Stockton, CA 95205-4152 (209) 464-8333 FAX (N�!'i'6'48349 <br /> California Contractor License 309105 A-C61ID40 HADHIC E-mail sssecoL(�Pacbell.net <br /> 1. FACILITY INFORMATION <br /> Facility Name: BANK OF STOCKTON,AIRPORT I Date of Testing: June 20,2006 <br /> Facility Address: 1941 E.Lockheed Court,Stockton,CA 95206 Phone: 209.483.0257 <br /> Facility Contact: Norman White <br /> Date Local Agency Was Notified of Testing: June l4,2006 <br /> Name of Local Agency Inspector(if present during testing) <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Stockton Service Station Eguipment Co.,Inc. <br /> Teclinician,Conducting Test: Randy Chadwick <br /> Credentials: [X]CSLB Licensed Contractor SWRCB Licensed Tank Tester <br /> License Type: C-61/D40 HAZ/HIC License Number: 309105 <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> Smith Fiberglass Products Company N/A <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> TANK ANNULAR TESTING x <br /> SECONDARY PIPE TESTING x <br /> PIPEING SUMP TESTING x <br /> SPILL/OVERFILL CONTAINMENT BOX x <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> PAGE 5 and 6 N/A <br /> TEST WATER LEFT ON SITE FOR CERTIFIED WASTE HAULER TO DISPOSE OF. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements. <br /> Technician's Signature: Zgnd wicre Date: June 20, 2006 <br /> V Chad <br />