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f � <br /> SECONDARY CONTAINMENT TESTING - REPORT FORM <br /> TESTING DATE: December 20, 2003 <br /> 1. OWNER INFORMATION <br /> Name Fred Esfandiary <br /> Address 310 Brianne Court, Pleasanton, CA 94566 Phone# 408-807-9839 <br /> Contact Fred Esfandiar <br /> 2. FACILITY INFORMATION <br /> Name Mr. Cafe <br /> Address 713 North EI Dorado Street, Stockton, CA 95202 Phone# 408-807-9839 <br /> Contact Fred Esfandiar <br /> 3. LOCAL AGENCY INFORMATION <br /> Name San Joaquin County Environmental Health Notified December 18, 2003 <br /> Address 304 East Weber Avenue, Stockton, CA 95202 Phone# 209-468-9847 <br /> Contact UST Team Fax# 209-468-3433 <br /> Inspector Present None <br /> 4. TESTING CONTRACTOR INFORMATION <br /> Name Walton Engineering, Inc. Lic# 617238 A, B, Haz <br /> Contact Michael Walton Phone# 916-373-1152 <br /> Address P.O. Box 1025, West Sacramento, CA 95691 Fax# 916-373-1172 <br /> Test Technician James Da <br /> 5. SUMMARY OF TEST RESULTS <br /> Number of Tank Annulars 0 Number of Spill Containers 3 <br /> Number of Secondary Lines 3 Number of UDC's Tested 6 <br /> Number of Piping Sumps 3 <br /> Component Pass Fail Component Pass Fa <br /> Annular-Tank#1 Gasoline-87 Spill Container#1 Gasoline-87 • <br /> Annular-Tank#2 Gasoline-91 Spill Container#2 Gasoline-91 • <br /> Annular-Tank#3 Diesel Spill Container#3 Diesel • <br /> Secondary Line#1 Gasoline-87 • U D C#1 Disp#112 • <br /> Secondary Line#2 Gasoline-91 • U D C#2 Disp#3/4 • <br /> Secondary Line#3 Diesel • U D C#3 Disp#5/6 • <br /> U D C#4 Disp#7/8 • <br /> U D C#5 Disp#9/10 • <br /> Piping Sump#1 Gasoline-87 • U D C#6 Disp#11/12 • <br /> Piping Sump#2 Gasoline-91 • <br /> Piping Sump#3 Diesel • <br /> 6. COMMENTS <br /> This is a full system "completion of construction"test. <br /> Technician Signature ti' Date <br /> �; 2003 Walton Engineering,IV <br />