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190410-653 UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 1 of 6) ;Typef Action ❑ Installation Test ❑ Repair Test ❑ Six Month Test 0 36 Month Test 1 . FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10181481 05/21 / 19 Business Name (Same as Facility Name or DBA-Doing Business As) Manteca CA FO REGEN Business Site Address City ZIP Code 2551 E . Louise Ave . Lathrop 195330 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification) Phone # Leonardo Aguilar (888 ) 588-8737 Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date 703190 5302718- UT 1 /4/20 III . SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID : (By tank number, stored product, etc.) A ti diesel B C D Tank Containment Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Product Piping Containment Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail [INA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail 0 NA E Pass ❑ Fail ❑ NA ❑ Pass E Fail ❑ NA E Pass ❑ Fail E NA Communication Test Result ❑ Pass ❑ Fail 0 NA E Pass ❑ Fail ❑ NA ❑ Pass E Fail ❑ NA C Pass ❑ Fail E NA Vent Piping Containment Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail [INA Communication Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail 2 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Turbine / Product Piping Sump Tightness Test Result ❑ Pass ❑ Fail 0 NA E Pass ❑ Fail ❑ NA ❑ Pass C Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result 10 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail [INA VENT / TRANSITION SUMP ID: a transition bo b C d Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail 0 NA UDC ID: 1 12 3 4 Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID: 5 6 7 8 Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID: 9 10 11 12 Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA All items marked "Fait" or "NA " must be explained in their respective "COMMENTS " section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the secondary containment was tested in accordance with California Code of Regulations , Title 23 , Division 3 , Chapter 16, Section 2637 and all the information contained herein is accurate. UST Service Technician Signature Digitally signed by Leonardo Aguilar Leonardo Aguilar Date : 2019 . 05 .21 09 :46 :27 -07'00' CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council, NA = NotApplicable, UDC = Under- Dispenser Cottainment QA/QC APPROVED 5/23/201912 : 27 PMMike P . B