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SWRCI3..Jamiary 2002 PaL)e 1. This form is intended for use by contractors peiforming periodic testing of UST secondary containment systems. I se the appropriate pages of this form to report results for all components tested The completed form, written test procedures, and printouts from tests (if applicable), should be provided to the facility owner operator fo• submittal to the local regulatory agency. , 111111 1111111111111111111111111! , i' 1 Facility Name: ARCO 06347, CC 18022951 DateofTesting: 10/05/2006 Facility Address: 2430 JOE POMBO PARKWAY @ WEST GRANTLINE ROAD, TRACY, CA, 95376 Facility Contact: MARK SHAW Phone: (800) 964-0180 Date Local Agency Was Notified of Testing CSLB Licensed Contractor Name of Local Agency Inspector (if present during testing): SWRCB Licensed Tank Tester 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: JOEY MESA Credentials: CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type: Manufacturer License Number: Manufacturer Training Component(s) Date Training Expires Spill Box 1-87 1-87/WAS Spill Box 2-87 2-87 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 in full compliance with legal requirements Technician's Signature: flit A Date: 10/05/2006 K,� Spill Box 1-87 1-87/EAS Spill Box 1-87 1-87/WAS Spill Box 2-87 2-87 Spill Box 3-913-91 000 ��00 0000 aoc�o 0000 0000 0000 0000 00oo 0000 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 in full compliance with legal requirements Technician's Signature: flit A Date: 10/05/2006 K,�