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JUN -04-2008 14:50 Service Station Systems 408 938 8888 P.16/19 <br />Seconctry Containment Testing Repo For <br />This form is intendedfor use by contractors performing periodic testing of US`Tsecondary containment systems. Use the <br />appropriate pages of this forni 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/operator far submittal to the local regulatory agency. <br />1 1. FACILITY INFORMATION <br />Facility Name: Shell # 136187 Date of Testing: 5/21/08 <br />Facility Address: 2375 W. Grantline Road — Tracy CA 95376 <br />Facility Contact: Phonc: <br />Date Local Agency Was Notified of Testing; SB989 — Repair/Retest <br />Name of Local Agency Inspector (if present during testing): <br />2. TESTING CONTRACTOR INFORMATION <br />3. SUMMARY OF TEST RESULTS <br />Component: Pass Fail Not Repairs <br />Tested Made <br />Component: Pass Fail Not Repairs <br />Tested Made <br />87 A Turbine Sump <br />89 B Turbine Sump p <br />I <br />91 A Turbine Sump L <br />D <br />DSL Turbine Sump cm <br />[i1 <br />DSL Fill Sump ® <br />J <br />89 Fill Bucket t <br />p <br />87 Vapor Bucket li?J <br />p <br />If hydrostatic testing was pedormed, 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 />