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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 FacilityName: CONOCO PHILLIPS #2705446 DateofTesting: 04/04/2008 Facility Address: 1403 COUNTRY CLUB BLVD , STOCKTON, CA, 95204 Facility Contact: MANAGER Phone: (2 0 9) 943-2082 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: MATTHEW HASLEY Credentials: CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester RIME License Type: Manufacturer I License Number: 5 2 5 9 4 31- UT Manufacturer Training Component(s) Date Training Expires tanknology all 05/29/2009 _000 g Sump 2 REG,Piping 3. SUMMARY OF TEST RESULTS If hydrostatic testing was performed, describe what was done with the water after completion of tests: site to site 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: ", s Date: 04/04/2008 RIME RU, Piping Sump I DIE _000 g Sump 2 REG,Piping ��00 Sump 3 SUP 000 ��DO If hydrostatic testing was performed, describe what was done with the water after completion of tests: site to site 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: ", s Date: 04/04/2008