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SWRCB; January 2002 Page 1. Seconda y Containment Testing Replot Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. Facility Name: TE I CHERT CONSTRUCTION Date of Testing: 03/02/2007 Facility Address: 120 FRANK WEST CIRCLE STOCKTON, CA, 95206 Facility Contact: GEORGE Phone: ( 916) 386-3716 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: DENNIS RUE Component Credentials: CSLB Licensed Contractor El SWRCB Licensed Tank Tester License Type: Manufacturer License Number: Manufacturer Training Component(s) Date Training Expires Spill Box 1 DIE FILL Spill Box 2 UNL FILL 3. SUMMARY OF TEST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ,""f, Date: 03/02/2007 Component Spill Box 1 DIE FILL Spill Box 2 UNL FILL Spill Box 3 WAS000 1„��00 r�000 a000 0000 0000 0000 � o000 0000 0000 If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: ,""f, Date: 03/02/2007