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SWRCB, January 2002 Page 1. Secondary Containment Testing Report Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use 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 for submittal to the local regulatory agency. 1. FACILITY INFORMATION Facility Name: ARCO #02186, CC 18022645 DateofTesting: 05/13/2008 Facility Address: 3212 N. CALIFORNIA @ ALPINE AVE. PTO # N-79, STOCKTON, CA, 95210 Facility Contact: MGR - KEVIN Phone: (2 0 9) 941-2694 Date Local Agency Was Notified of Testing: 04/28/2008 Name of Local Agency Inspector (if present during testing): ARIS CACAPIT 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Pass Technician Conducting Test: JOEY MESA Repairs Made Credentials: ❑ CSLB Licensed Contractor Not Tested SWRCB Licensed Tank Tester Spill Box 1 REG FILL License Type: ICC SERVICE TECH. License Number: 5259458 -UT ❑ Manufacturer Manufacturer Training Component(s) Date Training Expires OPW SPILL BUCKET 01/18/2010 a Spill Box 1 REG FILL [K] ❑ ❑ ❑ ❑ ❑ 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair ss Made Spill Box 1 REG FILL El ❑ ❑ ❑ ❑ ❑ ❑ a Spill Box 1 REG FILL [K] ❑ ❑ ❑ ❑ ❑ ❑ ❑ Spill Box 2 REG FILL ff] ❑ ❑ ❑ ❑ ❑ ❑ ❑ Spill Box 3 PRE FILL El ❑ ❑ ❑ ❑ ❑ ❑ ❑ El El El El El E El El El El 0 E] El El E El El El El E El El El E El El El El 0 El El E El Ell Ell El If hydrostatic testing was performed, describe what was done with the water after completion of tests: LEFT IN WASTE DRUM ONSITE. 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:Date: 05/13/2008