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0 <br />SECONDARY CONTAINMENT REPORT FORM <br />TESTING DATE: 11 <br />1. OWNER INFORMATION <br />Name Pete Graffigna VIFiONENT NELT <br />Address 1301 W. Kettleman Ln., Lodi, CA 95242 E q�SE 4-3233 <br />Contact Pete Graffigna <br />2. FACILITY INFORMATION <br />Name Flame Mini Mart <br />Address 1301 W. Kettleman Ln., Lodi, CA 95242 Phone # 209-334-3233 <br />Contact Pete Graffiana <br />3. LOCAL AGENCY INFORMATION <br />Name San Joaquin County Environmental Health Notified July 29, 2002 <br />Address 304 E. Weber Ave., 3rd Fir., Stockton, CA 95202 Phone # 209-468-9847 <br />Contact Michele Sterni -Le Fax# 209-468-3433 <br />Inspector Present <br />4. TESTING CONTRACTOR INFORMATION <br />Name Walton Engineering, Inc. Lic#/Class 617238 A, B, Haz'. <br />Contact Michael Walton Phone # 916-373-1152 <br />Address P.O. Box 1025, West Sacramento, CA 95691 <br />Test Technician James Dav <br />5. SUMMARY OF TEST RESULTS <br />Number of Tanks Tested <br />Number of Piping Sumps Tested <br />2 <br />3 <br />Number of Piping Runs Tested 3 <br />Number of UDC Boxes Tested 4 <br />Component <br />Pass Fail <br />Comments <br />Annular - Tank #1 <br />Gasoline - 87 <br />• <br />O <br />Annular - Tank #2 <br />Gasoline - 91 <br />• <br />O <br />Annular - Tank #3 <br />Diesel <br />2nd compartment of a 2 compartment tank. No testing performed. <br />Secondary Pipe #1 <br />Gasoline - 87 <br />• <br />O <br />Secondary Pipe #2 <br />Gasoline - 91 <br />• <br />O <br />Secondary Pipe #3 <br />Diesel <br />• <br />O <br />Piping Sump #1 <br />Gasoline - 87 <br />• <br />O <br />Piping Sump #2 <br />Gasoline - 91 <br />• <br />O <br />Piping Sump #3 <br />Diesel <br />• <br />O <br />U D C #1 <br />Disp # 1/2 <br />• <br />O <br />U D C#2 <br />Disp # 3/4 <br />• <br />O <br />U D C#3 <br />Disp # 5/6 <br />• <br />O <br />U D C#4 <br />Disp # 7/8 <br />• <br />O <br />Watton Engineering, Inc. <br />Technician Signature <br />Date <br />