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SWRCB, January 2002 0 is `)econdary Containment' Report1 Page 1. This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests (f applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: CONOCO PHILLIPS #2705447 1 DateofTesting: 07/21/2006 Facility Address: 1469 E HAMMER LANE STOCKTON, CA, 95209 Facility Contact: MANAGER Phone: (2 0 9) 478-1522 Date Local Agency Was Notified of Testing: / / Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR 1' 1 Company Name: TANKNOLOGY, INC. Technician Conducting Test: RAYMOND SIMMS Credentials: ❑ CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type: Manufacturer License Number: Manufacturer Training Component(s) Date Training Expires Spill Box 87 Spill Box 8 Spill Box 89 3. SUMMARY OF TEST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and infill compliance with legal requirements Technician's Signature: lr� Date: 07/21/2006 J' Spill Box 87 Spill Box 87 Spill Box 8 Spill Box 89 Spill Box 91 Spill Box 91 Spill Box dsl l�■000 ��0� If hydrostatic testing was performed, describe what was done with the water after completion of tests: CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the facts stated in this document are accurate and infill compliance with legal requirements Technician's Signature: lr� Date: 07/21/2006 J'