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Jan. 19. 2009 1 : 09PM West Star Environmental, Inc. No. 7703 P. 2/7 Page Io#i <br /> SWRCB,January 2002 <br /> Seco dart' Containment Testing Roport, Form <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the <br /> appropriate,pages of this form to report results for all components tested The completed form, written test procedures,and <br /> print outs from tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: ESCALON MINI MART Date of Testing: 11/18/08 <br /> Facility Address: 1097 E.YOSEMITE <br /> Facility Contact: BILLPhone: 209-838-1546 <br /> Date Local Agency Was Notified of Testing 11.03.08 <br /> Name of Local Agency inspector(cfpresent curing testing): MUNjApPA NAIDU <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: WEST STAR ENVIRONMENTAL, INC. <br /> Technician Conducting Test JASON ESQUEDA <br /> Credentials: CSLB Licensed Contractor x SWRCB Licensed Tank Tester <br /> License Type: /-HAZ License Number: 605142 <br /> manufacam:Trnlnln� <br /> Manufacturer Cotnponent(s) Date Training Expires <br /> kIlL TIT/BUCKETS <br /> APT/LINES <br /> STERN FIBERGLASS/SUMPS/PANS <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass FailNot Rep <br /> 1 Not ReMade Component Pass Fall Tested Made <br /> SPLIT ULA LINES RUN#2 <br /> 87 FILL BUCKET x LINES RUN#3 <br /> 87 VAPOR BUCKET X LINES RUN#4 <br /> 91 FILL BUCKET x 91 SECONDARY LINE RUN#1 <br /> 91 VAPOR BUCKET X <br /> 87 STP SUMP <br /> 91 STP SUMP X <br /> ISP 1&2 X <br /> ISP W <br /> DISP 5&6 X <br /> ISP 7&8 <br /> 87 SECONDARY RUN#1 <br /> If hydrostatic testing was performed,describe what was done with the water after completion of tests:LEFT ON SITE IN HAZ <br /> BARRELS <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> ro the best of my knowledge,the fads In this document are accurate and u frau conVilance with legal requkentena <br /> Technician's Signature: Date:11/18/08 <br />