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This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form an, <br />printouts from tests (if applicable), should be provided to the facility owner/operator for submittal to the local regulatory agency. <br />1. FACILITY INFORMATION <br />Facility Name: United Parcel Service I Date of Testing: 6-12-2008 <br />Facility Address: 1532 North Broadway — Stockton, CA 95205 <br />Facility Contact: Herman Meyer — Plant Engineering I Phone: (916) 373-4001 <br />Date Local Agency Was Notified of Testing: 5-29-2008 <br />Name of Local Agency Inspector (fpresent during testing): Ray von Flue— San Joaquin County E.H.D. <br />Company Name: PETRO-TECHZ Environmental Services <br />Technician Conducting Test: Dan Zeman <br />Credentials': 0 CSLB Contractor X ICC Service Tech. X SWRCB Tank Tester 0 Other (Specify) <br />License Number(s): ICC Service Technician No.: 5243781 -UT — CA SWRCB Tank Tester License No.: 1535 <br />Test Method Used: Hydrostatic Vacuum Other: <br />Test Equipment Used: Caldwell "Level Change Indicator" Equipment Resolution: .01" <br />Identify Spill Bucket (By Tank 1 Unleaded <br />Number, Stored Product, etc. <br />Bucket Installation Type: Direct Bury <br />Bucket Diameter: 11" <br />Bucket Depth: 13" <br />Wait time between applying 15 Minutes <br />vacuum/water and start of test: <br />Test Start Time (Tj): 9:20 am <br />Initial Reading (RO: 121/2" <br />Test End Time (TF): 10:20 am <br />Final Reading (RF): 12 ''h" <br />Test Duration (TF— TI): 60 Minutes <br />Change in Reading (RF- RI): 0.00 <br />Patss/Fail Threshold or 1/4" in a 24 Hr. Period <br />Criteria: <br />Test Result: Pass <br />Comments — (include information on repairs made prior to testing, and recommended follow-up for failed tests) <br />Test H2O was stored in an on site liquid waste drum. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained in this report is true, accurate, and in full compliance with legal requirements <br />Technician's Signature: .. _ Date: June 12, 2008 <br />Page 5 of 5 <br />