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�3 <br />2560 Soquel Avenue A2 , <br />Santa Cruz CA 95062 1 <br />T: 831.475.8141;;. a <br />F: 831.475.8249 <br />CA Lic# 693807 A-HAZ B-HIC <br />Secondary Containment Testing Report Form <br />1 V-1.4— ;1.4— r„ r a: <br />Facility Name: Valero 3641 <br />Date of Testing: 07/09/09 <br />Facility Address: 1210 E. Hammer Ln. Stockton, CA 95210 <br />Facility Contact: <br />Phone: 209-477-3111 <br />Date Local Agency Was Notified of Testing : 07/02/2009 <br />Name of Local Agency Inspector (if present during testing): <br />1. 'Yesting Contractor Information <br />Manufacturer Component Expiration Date <br />Incon Leak Detector 12/15/10 <br />Component P 3�FN <br />of Test Results <br />I RM Component <br />P <br />F <br />NT <br />RM <br />Spillbox: All <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 />- <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ ❑ <br />❑ — <br />❑ <br />❑ -❑ <br />❑- <br />CERTIFICATION TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the cts tated in tli"ocunA are accurate and in full compliance with legal requirements <br />Technician's Signature: Date: 07/09/09 <br />Technician's Name: Anathan drkpr <br />lof2 <br />