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20201085 UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 1 of 6) Type of Action ❑ Installation Test ❑ Repair Test EI Six Month Test 2136 Month Test I. FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10180733 4113/2020 Business Name (Same as Facility Name or DBA-Doing Business As) Arco 7147 Business Site Address City ZIP Code 1206 E March Lane Stockton 95210 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification) Phone # Bodo Sanchez (925) 551 -7555 Contractor I Tank Tester Ucense # ICC Certification # ICC Certification Expiration Date 220793 8887127 6/4/2020 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID: (By tank number, stored product, etc.) A 87 B 91 C DSL D Tank Containment Tightness Test Result M Pass ❑ Fail ❑ NA O Pass ❑ Faii ❑ NA I@ Pass ❑ Fail ❑ NA p Pass ❑ Fail O NA Product Piping Containment Tightness Test Result IO Pass ❑ Fall ❑ NA M Pass ❑ Fall ❑ NA O Pass ❑ Fail ❑ NA ❑ Pass O Fall ❑ NA Communication Test Result ❑ Pass ❑ Fall M NA Q Pass ❑ Fall M NA ❑ Pass Cl Fall S NA ❑ Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail I@ NA ❑ Pass ❑ Fall M NA ❑ Pass ❑ Fall M NA ❑ Pass ❑ Fail ❑ NA j Communication Test Result ❑ Pass ❑ Fail M NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail 121 NA ❑ Pass ❑ Fall D NA Vent Piping Containment r Tightness Test Result D Pass ❑ Fail O NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fall p NA ❑ Pass Q Fall ❑ NA t Communication Test Result D Pass ❑ Fall CI NA [3 Pass ❑ Fail p NA [3 Pass ❑ Fall O NA C3 Pass [3 Fall ❑ NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fall p NA ❑ Pass ❑ Fail A NA ❑ Pass ❑ Fall M NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fall p NA ❑ Pass ❑ Fall Gi NA CI Pass ❑ Fail O NA ❑ Pass ❑ Fail ❑ NA Turbine I Product Piping Sump Tightness Test Result El Pass ❑ Fall ❑ NA O Pass ❑ Fail ❑ NA p Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result ❑ Pass ❑ Fall Q NA ❑ Pass ❑ Fall El NA ❑ Pass ❑ Fall O NA ❑ Pass ❑ Fail ❑ NA VENT I TRANSITION SUMP ID: a b C d Tightness Test Result ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fall ❑ NA UDC ID: 1 2 3 4 Tightness Test Result M Pass ❑ Fail ❑ NA M Pass ❑ Fall ❑ NA M Pass ❑ Fall ❑ NA El Pass ❑ Fall ❑ NA UDC ID: 5 6 7 8 Tightness Test Result p Pass ❑ Fall ❑ NA O Pass ❑ Fall ❑ NA ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fall ❑ NA UDC ID: 9 10 11 12 Tightness Test Result [3Pass [3 Fall [3 NAA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fall ❑ NA All ifems marked "Faii" or "NA " must be explalned in their respective "COMMENTS" section. iV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the secondary containment was tested I ccordance with California Codp o Regula}ionsjItle 23, Division 3 Chapter 16, Section 2637 and all the Info tion contal hereIrWs accurate. UST Service Technician Signature tr CERS = Caftria Erukonmemal Reporting System, ID = IderrtifCation, UST = Underground Storage Tank, ICG = IntematiorW Code Counct, NA NotAppfcable = Under.