Laserfiche WebLink
Secondary Containment Testing Report Form <br />This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the <br />appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: AT&T Corporation Date of Testing: 5/18/11 <br />Facility Address: 110 W. Turner Road — Lodi CA 95242 GEOPAR: UE231 <br />Facility Contact: Connie Mitchell Phone: (209) 474-4022 <br />Date Local Agency Was Notified of Testing: 4/15/11 Secondary Containment (SB989) <br />Name of Local Agency Inspector (if present during testing): Aris Cacapit <br />Technician's Signature: [/c �� - Date: 5/18/11 <br />