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4 . ,i <br /> SWRCB,January 2002 Page of <br /> Secondary Containment Testing Report <br /> This form is intended for use by contractors performing periodic testing of U,ST secondary containment systems. Use the <br /> appropriate pages of this form to report results for all components tested The completedform,written test procedures, and <br /> printouts from tests(rf applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACKM EWORMATION <br /> Facility Name: Teichert Mobile Equipment I Date of Testing: 1/6/17 <br /> Facility Address: 120 Frank West Circle,Stockton Ca 95206 <br /> Facility Contact: Steve Schamaun Phone: 916-386-3767 <br /> Date Local Agency Was Notified of Testing: 1/3/17 <br /> Name of Local Agency Inspector(fpresent during testing): <br /> 2. TESTING CONTRACTOR O TION <br /> Company Name: 7P Petroleum Service <br /> Technician Conducting Test: Gabe Garcia <br /> Credentials: x CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester <br /> License Type: A License Number: 811471 ICC#5281582 <br /> MEMMORMINSEW <br /> Manufacturer Training <br /> Manufacturer Com nen s Date TTininE fres <br /> 3. SUMMARY OF TEST RESULTS <br /> Not Repairs Not Repairs <br /> Component Pass Fail T Made Component Pass Fail .I ested Made <br /> Annular 1 x ❑ ❑ ❑ UDC 1&2 x ❑ ❑ ❑ <br /> Annular 2 x ❑ ❑ ❑ UDC 3&4 x ❑ ❑ ❑ <br /> Annular 3 x ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Line 1 x ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Line 2 x ❑ ❑ ❑ ❑ ❑ ❑ 0 <br /> Line 3 x ❑ ❑ ❑ ❑ ❑ ❑ 0 <br /> Line 4 x 0 ❑ ❑ ❑ ❑ ❑ ❑ <br /> Line 5 x ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Sump 1 x ❑ ❑ ❑ ❑ ❑ ❑ 0 <br /> Sump 2 x ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> Sump 3 x ❑ 1 0 ❑ ❑ ❑ ❑ ❑ <br /> ❑ ❑ 1 ❑ ❑ ❑ i ❑ ❑ ❑ <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Water was filtered and returned to holding <br /> CERTIFICATION OF TECHNICIAN N LE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the facts stat d In do <br /> Js docunwntare accurate and In full compliance wfth le re udrements <br /> Technician's Sign Date: /— <br /> CEIVEDJAN 13 7 <br /> EWROWENTAL H84LTH <br /> PERMITlSERihCES <br />