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RECEIVED Secondary Containment Testing Report Form IAA:=; 0 6 2014 This form is intended for use by contractors performing periodic testing of UST secondary containme` appropriate pages of this form to report results for all components tested. The completed form, writt!'�r TAL printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to th ` uet�jT 4. FACILITY INFORMATION Facility Name: Love's Fuel Center (Cover Page 11) Date of �1*csting: 1/ 14& 15, 2014 Facility Address: 1553 Colony Rd., Ripon, Ca. 95366 Facility Contact: Kevin Nickell Phone: (405) 380-5796 Date Local Agency Was Notified of Testing: 12/16/13, by Afford -A -Test Name of Local Agency Inspector (f present during testing): 5. TESTING CONTRACTOR INFORMATION Company Name: R&D Compliance "Testing Technician Conducting Test: Benjamin F. Duncan Jr. Credentials: ❑ CSLB Licensed Contractor X SWRCB Licensed Tank Tester License Type: Tank Tester License Number: 90-1120/ICC #5246802 -UT Manufacturer Training Manufacturer Component(s) Date Training Expires Pass Fail Not Tested Repairs Made 6. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repairs Made Dispenser Sump #3&4 X ❑ ❑ ❑ Dispenser Sump #23s&24m ❑ ❑ X ❑ Dispenser Sump #5&6 X ❑ ❑ ❑ Dispenser Sump #24s&25m ❑ ❑ X ❑ Dispenser Sump #7&8 X ❑ ❑ ❑ Dispenser Sump #25s&26m ❑ ❑ X ❑ Dispenser Sump #9&l0 X ❑ ❑ ❑ Dispenser Sump #26s&27m ❑ ❑ X ❑ Dispenser Sump 411&12 X ❑ ❑ ❑ Dispenser Sump #27s ❑ ❑ X ❑ Dispenser Sump #13&14 X ❑ ❑ ❑ Fill Riser Sump #1 X ❑ ❑ ❑ Dispenser Sump #15&16 X ❑ ❑ D Fill Riser Sump #2 X ❑ ❑ ❑ Dispenser Sump #17&18 X ❑ ❑ ❑ Fill Riser Sump #3 X ❑ ❑ ❑ Dispenser Sump #19&20 X ❑ ❑ ❑ Fill Riser Sump #4 X ❑ ❑ ❑ Dispenser Sump # 21m ❑ ❑ X ❑ Fill Riser Sump #5 X ❑ ❑ ❑ Dispenser Sump # 21 s&22m ❑ ❑ X ❑ ❑ ❑ ❑ ❑ Dispenser Sump # 22s&23m ❑ ❑ X ❑ ❑ ❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: Test Fluid Supplied by Site and Disposed of in On Site Separator Tank. See comments pages 6 & 12 of this Report for components not tested. 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:s!/unctr G Date: January 14&15, 2014