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ACRE, August 2003 Page I of <br />Secondary Containment Installation Testing Report <br />This form is intended for use by inspection staff performing testing during installation of UST .secondary containment systems. Use the <br />appropriate pages ofthis form to report results for all components tested The completed forms, written test procedures, and printouts from tests <br />(if applicable), shall be used in evaluating the installation of new equipment and repairs to existing equipment. <br />2. TESTING CONTRACTOR INFORMATION <br />Company U.S.T. Compliance Testing Inc. <br />Technician Conducting Test: Tony Fontana / Bill McCarthy <br />T'Credentials. x CSLB Licensed Contractor x SWRCB Licensed Tank Tester <br />License Type: A Gen. Eng. #846288 License Number:92-1153 /91-1151 <br />Contractor's Manufacturer Traininy- <br />Manufacturer Component(s) Date Training Expires <br />In -Con TS- STS 3-20-06 <br />Component <br />Pass <br />Fail <br />Not <br />Tested <br />Repairs Component <br />Made <br />Pass <br />Fail <br />Not <br />Tested <br />Repairs <br />Made <br />1!51 A:, t <br />El <br />El <br />11 <br />0 <br />0 <br />El <br />FTI Slip 5-2t� �% <br />5d <br />0 <br />0 <br />C <br />[1 <br />0 <br />11 <br />1 Lj <br />Fi <br />Lj <br />E <br />El <br />LE <br />F-,' <br />Ljo<- t- <br />❑ <br />11 <br />El <br />Ej <br />U <br />.0 <br />-2 <br />,�, <br />11 <br />El <br />11 <br />❑ <br />0 <br />0 <br />L-1 <br />0 <br />El <br />11 <br />El <br />11 <br />11 <br />El <br />11 <br />El <br />FF <br />FFE-j <br />El <br />❑ <br />0 <br />0 <br />0 <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />Water placed in 55 Gal. drums & left on site <br />Inspector's Sigpriature. Date: <br />