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2560 Soquel Avenue Ste <br />Santa Cruz CA 95062 <br />T: 831.475.8141 <br />F: 831.475 * 8249 <br />CA Lic# 693807 A-HAZ B-HIC <br />CONSTRUCTION <br />1. Facility Information <br />Facility Name: Valero 3641 <br />Facility Address: 1210 East Hammer Ln. Stockton, CA 95210 <br />Facility Contact: <br />Date Local Agency Was Notified of Testing : 06/28/2012 <br />Name of Local Agency Inspector (if present during testing): Garrett Backus <br />Date of Testing: 07/11/2012 <br />. . _ ..... _ ._. <br />Phone: 209-477-3111 <br />2. <br />Testing Contractor Information <br />Manufacturer <br />Component <br />Expiration Date <br />3. Summary of Test Results <br />Component P <br />F NT RM Component <br />T P <br />F <br />NT <br />RM <br />Spill Buckets: All X❑ <br />-_ <br />❑ ❑ ❑ <br />- <br />❑ <br />- <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ ❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ ❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ . <br />❑ <br />❑ ❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ ❑ ❑ <br />❑ <br />❑ <br />-o <br />❑ <br />❑ <br />. ...- ......_ ... <br />❑ ❑ ❑ <br />. <br />❑ <br />❑ <br />❑ <br />El <br />❑ <br />❑ ❑ ❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: <br />Technician's Name <br />lof2 <br />Ocker <br />Date: 07/11/2012 <br />