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NO <br />5444 Dry Creek Road <br />Sacramento, CA 95838 <br />800-288-2657 <br />Tank No. Cap <br />ankl 15k <br />'anK� 10k <br />Product <br />Unleaded UW Unknown 112U" <br />Premium DW Unknown >120" <br />to GW Tank Bottom Product Level Brine Test Result <br />132 56 N Pass <br />156 27 N Pass <br />Tank Top Sumps Manufacturer Diameter (in.) Depth (in.) Volume al. Description Test Result <br />_. Unkno. 48 - 282.0 87 TS Pass <br />Unknovm 48 -6 282.0 91 TS Pass <br />UDCs <br />Manufacturer <br />Well Proximity Project Worksheet <br />Test Date: <br />1119112 <br />Technicians: <br />Ton 0 1 1 <br />Facility: <br />76 Gas Station <br />Contractor Name: <br />U.S.T Compliance Testing Inc. <br />Address: <br />574 West Grant Line Rd. <br />Address: <br />P.O Box 580 <br />City, State, zip: <br />Tracy, CA 95376 <br />City, State, zip: <br />Ceres , CA 95307 <br />County: <br />San Joaquin <br />Contact: <br />Tony <br />CUPAContact: <br />San Joaquin Environmental Health/Michelle Henry Telephone/Email <br />209-595-4489/ <br />Tank No. Cap <br />ankl 15k <br />'anK� 10k <br />Product <br />Unleaded UW Unknown 112U" <br />Premium DW Unknown >120" <br />to GW Tank Bottom Product Level Brine Test Result <br />132 56 N Pass <br />156 27 N Pass <br />Tank Top Sumps Manufacturer Diameter (in.) Depth (in.) Volume al. Description Test Result <br />_. Unkno. 48 - 282.0 87 TS Pass <br />Unknovm 48 -6 282.0 91 TS Pass <br />UDCs <br />Manufacturer <br />Length in. <br />Width (in.) <br />Depth nu, <br />Volume al. <br />Description <br />Test Result <br />UDC1 <br />Gilbarco <br />36 <br />28 <br />34 <br />148.4 <br />UDC 1 <br />Pass <br />UDC2 <br />Gilbarco <br />36 <br />28 <br />34 <br />148.4 <br />UDC 2 <br />Pass <br />UDC3 <br />Gilbarco <br />36 <br />28 <br />34 <br />148.4 <br />UDC 3 <br />Pass <br />UDC4 <br />Gilbarco <br />36 <br />28 <br />34 <br />148.4 <br />UDC 4 <br />Pass <br />Product Piping Manufacturer Type Size (in.) Test Result <br />Unleaded Westem Fiberglass Co -Flex 1 1/2" Pass <br />Premium Westem Fiberglass Co -Flex 1 1/2" Pass <br />Vent Piping Manufacturer Type Size in. Test Result <br />Unleaded AO Smith SW 2 Pass <br />Premium AO Smith SW 2 Pass <br />Va or Piping Manufacturer Type Size in. Test Result <br />Unleaded/ Premium AO Smith SW 2 Pass <br />Item Test Tested Sample ID Concentration Date Time Description (How 8. volume collected, Notes) <br />12/11/2012 <br />051703 <br />11/912012 <br />Reviewed By <br />Date <br />CA Tank Te ignature <br />CA License No. <br />Date <br />