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2560 Soquel Avenue Ste 202 <br />Santa Cruz CA 95062 <br />T: 831.475.8141 <br />F: 831.475.8249 <br />CA Lic# 693807 A-HAZ B-HIC <br />t•� <br />- s <br />CONSTRUCTION <br />Secondary Containment Testing Report Form <br />i. Faciuty information _ <br />Facility Name: Valero 3841 Date of Testing: 12104/2012 <br />Facility Address: 1210 E. Hammer Ln. Stockton, CA 95210 <br />Facility Contact: — Phone: 209-477-3111 <br />Date Local Agency Was Notified of Testing: 11/08/2012 <br />[Name of Local Agency Inspector (if present during testing): <br />2. Testing Contractor information _ <br />--_ --- -'--T-. - <br />Manufacturer Component Expiration Date <br />INCON-- �— TS -STS - — 12/13112 <br />3. Summary of Test Results <br />Is this a retest of previously failed components? ❑ Yes <br />Component P T FNT RM <br />Annulars:87 ® <br />❑ <br />❑ <br />❑ <br />Secondary Piping: 87 ® <br />❑ <br />❑ <br />❑ <br />Piping Sumps: 87 ® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />- ❑ <br />❑ <br />❑ <br />❑- <br />o <br />❑ <br />❑ <br />-a <br />❑ <br />❑ <br />o --o <br />❑ <br />❑ <br />❑ <br />❑ <br />CERTIFICA <br />To the best of my knowledl <br />Technician's <br />Technician's Natnq`. Jonati(an Ocker <br />I of 7 <br />Component = r l F Ni] <br />❑ <br />❑ <br />❑ <br />❑ <br />o <br />❑-❑ <br />a <br />- ❑ <br />❑ <br />❑ <br />❑- <br />YSIBLE FOR CONDUCTING THIS TESTING <br />are accurate and in full compliance with legal requirements <br />Date: 12/0412012 <br />