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tea, <br />2560 Soquel Avenue 002 <br />Santa Cruz CA 95062 <br />T: 831.475.8141 <br />F: 831.475.8249 <br />CA Lic# 693807 A-HAZ B-HIC RECEIVED <br />Secondary Containment Testing Report Form AUG 0 4 2011 <br />2. Testing Contractor Information <br />Manufacturer Component _ Expiration Date <br />I NCON TS -STS <br />12113/12 <br />3. Summary of Test Results <br />Is this a retest of previously failed components? ❑ YES <br />Facility Name: Valero 3641 <br />Date of Testing: 07/12/2011 <br />Facility Address: 1210 E. Hammer Ln. Stockton, CA 95210 <br />Facility Contact: <br />P I <br />F I <br />�Phone-.-477-3111 <br />Date Local Agency Was Notified of Testing : 06/3012011 <br />Name of Local Agency Inspector (if present during testing): Garrett Backus <br />I P <br />2. Testing Contractor Information <br />Manufacturer Component _ Expiration Date <br />I NCON TS -STS <br />12113/12 <br />3. Summary of Test Results <br />Is this a retest of previously failed components? ❑ YES <br />Component <br />P I <br />F I <br />NT <br />I RM <br />Component <br />I P <br />F <br />NT <br />RM <br />Annulars: All <br />N <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Secondary Piping: All <br />® <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Piping Sumps: All <br />® <br />❑ <br />❑ ❑ <br />❑ <br />❑— <br />❑ <br />❑ <br />Fill Sumps: All <br />❑X <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />Spill Buckets: All <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />LIDCs: All <br />❑X <br />❑ <br />❑ ❑ — -- <br />❑ <br />❑ <br />❑ . <br />❑ <br />❑ <br />❑ <br />❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />CERTIF4an <br />To the best of my know <br />Technician's Signature - <br />Technician's Na J <br />I of 7 <br />PONSIBLE FOR CONDUCTING THIS TESTING <br />ent are accurate and in full compliance with legal requirements <br />Date: 07/12/2011 <br />