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SWRCB, January 2002 Aft 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 Facility Name: CONOCO PHILLIPS #2705447 DateofTesting: 08/26/2008 Facility Address: 1469 E HAMMER LANE STOCKTON, CA, 95209 Facility Contact: MANAGER - TOM Phone: (2 0 9) 478-1522 Date Local Agency Was Notified of Testing: Name of Local Agency Inspector (if present during testing): CONTRACTOR2. TESTING INFORMATION Company Name: TANKNOLOGY , INC. Pass Fail Technician Conducting Test: BRIAN MCPHEELY Pass Fail Credentials: Repair Made CSLB Licensed Contractor SWRCB Licensed Tank Tester ❑ ❑ License Type: Manufacturer I License Number: Manufacturer Training Component(s) Date Training Expires ❑ ❑ Spill Box 1 SUP VAPOR x❑ ❑ ❑ Ell ❑ ❑ Spill Box 2 PLU FILL I"] 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Tested Repairs Made Component Pass Fail Not Tested Repair Made Spill Box 1 SUP FILL ❑ ❑ ❑ ❑ ❑ ❑ ❑ Spill Box 1 SUP VAPOR x❑ ❑ ❑ Ell ❑ ❑ Spill Box 2 PLU FILL I"] I ❑ ❑ ❑ ❑ ❑ ❑ ❑ Spill Box 2 PLU VAPOR a ❑ ❑ ❑ ❑ ❑ ❑ Q Spill Box 3 UNL FILL ❑ ❑ ❑ El ❑ El ❑ Spill Box 3 UNL VAPOR El ❑ ❑ E ❑ ❑ ❑ ❑ Spill Box 4 DIE FILL Ix] ❑ ❑ ❑ El ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑❑o❑ ❑❑❑❑ ❑❑❑❑ ❑❑❑❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑❑❑❑ ❑❑❑❑ 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: 23 Date: 08/26/2008