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2560 Soquel Avenue Ste <br />Santa Cruz CA 95062 �s <br />T: 831.475.8141 <br />F: 831.475.8249 <br />CA Lic# 693807 A -H, B-HIC <br />Secondary Containment Testing Report Form <br />1 Farilifu Tnfnrmnfinn <br />Facility Name: Valero 3641 <br />Date of Testing: 08/27/2009 <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: 08/18/2009 <br />Name of Local Agency Inspector (if present during testing): Garrett Backus <br />2. Testing Contractor Information <br />Manufacturer Component Expiration Date <br />INCON Leak Detector 12/15/10 <br />3. Summary of Test Results <br />Is this a retest of previously failed components? ❑ YES <br />Component P F NT RM Component P F I NT I RM <br />Secondary Piping: All Z ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br />UDCs: All ® <br />❑ <br />❑ <br />❑ <br />❑ <br />❑ <br />® <br />❑ <br />t <br />CERTIFICATIO OF W <br />PO <br />To the best of my knowledge, t e fac ocum t <br />3 <br />Technician's Signature:' <br />Technician's Nine: Jorlathan Ocker <br />1 of 7 <br />BLE FOR CONDUCTING THIS TESTING <br />accurate and in full compliance with legal requirements <br />Date: 08/27/2009 <br />