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04/19/05 TUE 09:30 FAX 9512705121 CIRCLE E STORES 9005 <br /> SWRCB,January 2002 Page 2 of (a <br /> 4. TANK ANNULAR TESTING <br /> Test Method Developed By: 0 Tank Manufacturer try Standard 0 Professional Engineer <br /> 0 Other(Spec) <br /> Test Method Used: 0 pressure acuum 0 Hydrostatic <br /> D Other(Specify) <br /> Test Equipment Used:i020 4f.0h,nEqu4)ment Resolution: <br /> Tank# l Tank# Tank# <br /> Is Tank Exempt From Testing?' D Yes iCNo 0 Yes ANo 0 Yes 0 No 0 Yes G No <br /> Tank Capacity: o oaf <> - <br /> Tank Material: H -- <br /> Tank Manufachrrer- - L- -- - <br /> Product Stored: <br /> Wait time between applying <br /> pressurelvacwm/water and <br /> starting test <br /> Test Siert Time: _-- <br /> Initial Reading(n: 1t5 46 /o 14e. <br /> Test EndTtme: D Za <br /> Final Reading(RF): <br /> Test Duration: j T'L ( If r2- <br /> Change in Reading(RF": <br /> Pass/Fail Threshold or Criteria: <br /> Test Result. - ❑ Pus' O Fa7r D.Pass QFaR 0 Pass; 041. U Pass-? 11 Fail <br /> Was sensor removed forwzlmg? CYes DNo DNA Oyes ONo DNA DYes i]No DNA 0Yes0N Ll NA <br /> Was sensorprolmlyreplaced and ❑Yes ONo DNA <br /> verified functional after testing? ❑Yes ❑No DNA ❑Yes 0N DNA ❑Yes ❑No DNA <br /> CoUtMents—(include information on repairs made prior to testing,=drecoMMended-fb17ow tT for ailed tests) <br /> Circle K #2701205 <br /> 16470 Cambridge Dr <br /> Lathrop, CA 95330 <br /> N04312—SB 989 testing <br /> 1 Secondary containment systems where the continuous monitoring automatically monitors both the prinuny and secondary <br /> containment,such as systems that are hydrostatically monitored or under constant vacuum,are exempt from periodic containment <br /> testing. (California Code of Regulations,Title 23,Section 2637(ax6)) <br />