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S WRCB,January 2002 page_of <br /> Secondary Containment Testing Report Form <br /> MID VALLEY CONSULTING <br /> AND GENERAL ENGINEERING <br /> 1097 BRONCO DRIVE,PLUMAS LAKE CA.95961 (530)749-9892 Ca Lick. 920085 CLASS A <br /> E-MAIL: midvalle.consultin@sbcglobal.net <br /> 1. FACILITY INFORMATION <br /> Facility Name: FAST AND EASY CHEVRON Date of Testing: 4/30/2015 <br /> Facility Address: 10878 N,HWY 99 STOCKTON CA,95212 <br /> Facility Contact: MIKEALI Phone: <br /> Date Local Agency Was Notified of Testing: 4/26/2015 <br /> Name of Local Agency Inspector(rf present during testing): <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Mid Valley Consulting <br /> Technician Conducting Test: JAMES DAY <br /> Credentials: CSLB Licensed Contractor <br /> License Type: CLASSA License Number:920985 <br /> Manufacturer Tiraining <br /> Manufacturer Component(s)) Date Training Expires <br /> INCON TS-STS 11/01/2015 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> 87 ANNULAR X I ❑ ❑ ❑ DISP 5-6 X ❑ ❑ ❑ <br /> 91/DIESELANNULAR X ❑ ❑ ❑ DISP 7-8 X ❑ ❑ ❑ <br /> 87 PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 91 T2 PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 91 Tl PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> DIESEL PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 87 STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 91 Tl STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> 91 T2 STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> DIESEL STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> DISP 1-2 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> DISP 3-4 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> if hydrostatic testing was performed,describe what was done with the water after completion of tests: <br /> Water will be removed from all tested containment sumps and filtered through <br /> a charcoal activated filtration system and returned to our on board storage <br /> Tank. <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge,the facts stated In this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: Date:4/3012015 <br />