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JUN -04-2008 14:43 Service Station Systems <br />408 938 8888 P.03 <br />Secon ry Containment Testing Repo orm <br />This fora is intended for use by contractors performing periodic testing of USTsecondury containment systems. Use the <br />appropriate pages of this form to report results for all components tested. The completed form., written test procedures, and <br />printouts from tests (if applicable), should be provided to the facility owner/operatorfor submittal to the local regulatory agency. <br />Facility Name: Shell # 136197 Date of Tcsting: 5/21/08 <br />Facility Address: 2375 W. Grantline Road - Tracy CA 95376 <br />Facility Contact: Phone: <br />Date local Agency Was Notificd of Tcsting : SB989 - 3yr. Compliance Test <br />Name of Local Agency Inspector (fj'present during testing): <br />S 1'. R OF TEST RESULTS <br />iJ p L n' t.. <br />Not f <br />Component- <br />... <br />1Repairs <br />Tank Annulars (wet annulars) <br />L-1 <br />i 89 A Secondary Product <br />Ali 016A <br />E3 <br />91 A Secondary Product <br />_. <br />).i87 <br />DSL Secondary Product <br />87 B Secondary Product <br />89 B Secondary Product <br />91 B Secondary Product <br />87 Fill Sump <br />87 A Turbine Sump <br />87 B Turbine Sump <br />ILD <br />DSL Fill Sump <br />• y •� <br />Fill Bucket; <br />k1-_ <br />91 A Turbine Sump <br />91 B Turbine Sump <br />91 Fill Bucket <br />DSL Turbine •! <br />aINIM <br />DSL Fill Bucket <br />all plea <br />ME <br />I87 <br />1! <br />Vapor Bucket-�' <br />all . <br />91 VaporBucket_ <br />If hydrostatic testing was performed, describe what was done with the water after completion of tests: <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br />Technician's Signature: Date - <br />SUMMARY <br />ate: <br />