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Rit, VI/It'llu <br /> SWRCR,January 2002 J�Uq"l 5,' 2 2006 0 <br /> ENV1R!J�N%1t­.N'f HE-ALTH Page I of 7 <br /> Secondary ContapifiM�jEjQj%g Report Form <br /> Stockton Service Station Equipment Co., Inc. <br /> 808 N. Union Street, Stockton, CA 95205-4152 (209)464-8333 FAX(209) 464-8349 <br /> California Contractor License 309105 A-C61/1)40 HAZ/HIC E-mail sssecoL�,pacbell.net <br /> 1. FACILITY INFORMATION <br /> Facility Name: BANK OF STOCKTON,AIRPORT Date of Testing: June 20,2006 <br /> Facility Address: 5000 S.Airport Way,Stockton,CA 95206 <br /> Facility Contact: Norman White Phone: 209.983.0257 <br /> Date Local Agency Was Notified of Testing: June 14,2006 <br /> Name of Local Agency Inspector(if present during testin <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Stockton Service Station Equipment Co.,Inc. <br /> Technician Conducting Test: Randy Chadwick <br /> Credentials: [X]CS]LBLicensed Contractor SWRCB Licensed Tank Tester <br /> _� <br /> License Type: C-61/D40 RAZ/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: Bgnc ► Chadw1cre Date: June 20, 2006 <br />