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SWRCB, January 2002 r <br />Secondary Containment Testing Report For <br />jREd0VC'9- <br />This forma intended for use by contractors performing periodic testing of UST secondw y containment syste X011 <br />appropriate pages of this form to report results for all components tested The completed form, written test procedures, and <br />printouts from tests {rfapplicable), should be provided to the facility owner/operator for submittal to the 1 Vi <br />I- FA _� ORMATION PER IT/ENEN ICES <br />2. TESTING CONTRACTOR TION <br />Company Name: JP Petroleum Service <br />Technician Conducting Test: Gabe Garcia <br />bulentials: x CSLB Licensed Confractor ❑ SWRCB Licensed"Tank Tester <br />License Type: A License Number: 811471 ICC #.5281582 <br />Manufacturer 'Training <br />FM <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water was filtered and returned toholding tank.. <br />CERTIFICA17ION OF NIMN RESPONSIBLE FOR CONDUCTING THIS TESrING <br />To the <br />r <br />bat J knowledge, � - ,. 1 V>rstatedIn this document 1 mce with legal requiremenit <br />MM <br />^int <br />, !.[ itt ki l:;j .��®® <br />'r,i .i <br />• I;i __" <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water was filtered and returned toholding tank.. <br />CERTIFICA17ION OF NIMN RESPONSIBLE FOR CONDUCTING THIS TESrING <br />To the <br />r <br />bat J knowledge, � - ,. 1 V>rstatedIn this document 1 mce with legal requiremenit <br />