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SWRCB, January 2002 FINAL DRAFT Page I of 7 <br />IM -11 P0 is I virvi #101 r, t 11 —Date o-ficsting: 7-17- nOF", <br />Facility address: Corral Hollow Road, Tracy.. CA 95376 Bift 879 TFUG01, TFUD01 <br />Facility Contact: Diane Griffin li� Phone: (925) 423-1547 <br />Date Local Agency was Notified of Testing: Notification by LLNL <br />Name of Local Agency Inspector (if present during testing): <br />DOXWORN I Ralt to] � fa I g I 11#,3_ M <br />M., I i ". 01 VE r I I <br />M-11-11-2 <br />Technician Conducting <br />Test: Brian Thornton <br />Credentials: <br />CSLB Licensed Contractor El SVVTRCB Licensed Tank Tester <br />License Type: A, C-10. HAZ 11 License Number: 724513 <br />ICC# 5024962 -UT <br />Manufacturer <br />Manufacturer Trainin <br />Component <br />is Training Expires <br />Veeder-Root <br />I k Monitor <br />06-07-2019 <br />R onan <br />Leak Monitor <br />08-12-2018 <br />INCON <br />Leak Monitor <br />08-22-2017 <br />Caldwell <br />Sump Level Change Indicator <br />05-22-2020 <br />I _ t' i "05 i t tI <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING TTIIS 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 Name (Please Print): BrianTbornton <br />Technician's Signature: /3 Date: — 7-17-2017 <br />