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COMPLIANCE ISSUES : 1ieconda Test: Complete 190814-533 UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM '(Page 1 of 6) Ty70fAction ❑ Installation Test ❑ Repair Test ❑ Six Month Test 0 36 Month Test L FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10181479 09/ 18/ 19 Business Name (Same as Facility Name or DBA-Doing Business As) Mid City Ca FO Regen Business Site Address City ZIP Code 13850 Devries Road Lodi 195242 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the /CC Certification) Phone # Leonardo Aguilar (888) 588-8737 Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date 703190 5302718-ut 1 /4/20 1116 SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID : (By tank number, stored product, etc.) A T1 DIESEL B C D Tank Containment 11 1 Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fail ❑ NA [I Pass ❑ Fail ❑ NA Product Piping Containment Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail R] NA [: . Pass ❑ Fail ❑ NA ❑ Pass C Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail 0 NA E! Pass ❑ Fail ❑ NA ❑ Pass C Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Vent Piping Containment Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA IV Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail RNA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Turbine ! Product Piping Sump Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA VENT / TRANSITION SUMP ID : a VENT BOX b PIPING VAULT C d Tightness Test Result 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 1 2 3 4 Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 5 6 7 8 Tightness Test Result ❑ Pass ❑ Fall 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID: 9 10 11 12 Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA All items marked "Fail" or "NA " must be explained in their respective "COMMENTS " section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the secondary containmentwas tested in accordance with California Code of Regulations , Title 23, Division 3, Chapter 16, Section 2637 and all the information contained herein is accurate . UST Service Technician Signature Digitally signed by Leonardo Aguilar Leonardo AgUIlar Date : 2019 . 09 . 18 14 :46 : 13 -07'00' CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council, NA = Not Applicable, UDC = Under- Dispenser Containment QA/QC APPROVED 9/20/20198 : 56 AMMegan Rodr