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Page 1 of 8 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 Facility Name: California Stop I Date of Testing: 10/08/08 Facility Address: 2224 S. Manthey, Stockton, CA 95206 Facility Contact: Nancy Lee I Phone: (209) 462-7621 Date Local Agency Was Notified of Testing : 09/10/2008 Name of Local Agency Inspector (if present during testing): Willie Ng 2. TESTING CUNTRACTUK INFUKMAIIUN Company Name: EPIC Compliance Systems, Inc. Technician Conducting Test: Keith A. Huston #5262044 -UT Credentials: 0 CSLB Licensed Contractor SWRCB Licensed Tank Tester License Tvoe: A License Number: 880430 Manufacturer Manufacturer Training 3_ SUMMARY OF TEST RESULTS Date If hydrostatic testing was performed describe what was done with the water after completion of tests: 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: Date: 10/08/08 Ell Tank 1 Annular Tank 2 Annular OQQQ QQQQ Tank 3 Annular QOQQ QQQQ 87 Sec. Piping 91 Sec.• •Diesel QQQQ QQQQ Sec. Piping 87 Piping Sump 91 Piping Sump Diesel Piping Sump If hydrostatic testing was performed describe what was done with the water after completion of tests: 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: Date: 10/08/08