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f .-% <br />SECONDARY CONTAINMENT TESTING - REPORT FORM <br />TESTING DATE: January 22, 2004 <br />I. OWNER INFORMATION <br />Name Quik Stop Markets <br />Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 <br />Contact Michael Karvelot <br />2. FACILITY INFORMATION <br />Number of Spill Containers <br />Number of UDC's Tested <br />i co <br />Name Quik Stop #138 1ju <br />o <br />w v <br />Component <br />Address 1153 Lincoln Blvd., Tracy, CA 95376,E <br />C=) <br />CC <br />Phone# 510-657-8500 <br />Contact Michael Karvelot <br />Spill Container #1 <br />z w <br />0 <br />TE7 <br />C= <br />Spill Container #2 <br />3. LOCAL AGENCY INFORMATION <br />m <br />z <br />Gasoline - 91 <br />Name San Joaquin County EnvironmentalI <br />Li.! <br />cc LU <br />Notified January 20, 2004 <br />Address 304 E. Weber Ave., Stockton, CA 9� <br />L.L. <br />a. <br />Phone # 209-468-9847 <br />Contact Tank Team <br />z <br />w <br />Fax # 209-468-3433 <br />Inspector Present None <br />U D C #1 <br />Disp # 1/2 <br />t. TESTING CONTRACTOR INFORMATION <br />Name Walton Engineering, Inc. Lic# 617238 A, B, Haz <br />Contact Michael Walton Phone # 916-373-1152 <br />Address P.O. Box 1025, West Sacramento, CA 95691 Fax # 916-373-1172 <br />Test Technician Scott Melvin <br />5. SUMMARY OF TEST RESULTS <br />Number of Tank Annulars 0 <br />Number of Secondary Lines 0 <br />Number of Piping Sumps 0 <br />Number of Spill Containers <br />Number of UDC's Tested <br />3 <br />0 <br />Component <br />Pass Fail <br />Component <br />Pass Fail <br />Annular - Tank #1 <br />Gasoline - 87 <br />Spill Container #1 <br />Gasoline - 87 <br />0 <br />Annular - Tank #2 <br />Gasoline - 89 <br />Spill Container #2 <br />Gasoline - 89 <br />• <br />Annular - Tank #3 <br />Gasoline - 91 <br />Spill Container #3 <br />Gasoline - 91 <br />• <br />Secondary Line #1 <br />Gasoline - 87 <br />U D C #1 <br />Disp # 1/2 <br />Secondary Line #2 <br />Gasoline - 89 <br />U D C #2 <br />Disp # 3/4 <br />Secondary Line #3 <br />Gasoline - 91 <br />Piping Sump #1 <br />Gasoline - 87 <br />Piping Sump #2 <br />Gasoline - 89 <br />Piping Sump #3 <br />Gasoline - 91 <br />6. COMMENTS <br />s an annual test <br />Technician Signature <br />D 2003 Walton Engineering, Inc. <br />Date 11<1' <br />