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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (page i of 6) Type ;Ac�fion ❑Installation Test ❑Repair Test ❑Six Month Test m 36 Month Test I. FACILITY INFORMATION CERS ID 10180759 Date of Secondary Containment Test 512912019 Business Name(Same as Facility Name or DBA-Doing Business As) Mobil 68222 Business Site Address City ZIP Code 2132 Mariposa Rd. Stockton 95205 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test(Print as shown on the ICC Certification) Phone# Michael McCarter (707)545-5522 Contractor 1 Tank Tester License 9 ICC Certification# ICC Certification Expiration Date Able Maintenance, Inc.-312844 8819839 10/25/2019 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID:(By tank number,stored product,etc.) A 87 B 89 C 91 D Diesel Tank Containment Tightness Test Result 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA Product Piping Containment Tightness Test Result ❑Pass 0 Fall ❑NA 0 Pass ❑Fall ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA Communication Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fall 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Remote Fill Piping Containment Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail [X NA ❑Pass []Fall [INA Communication Test Result ❑Pass ❑Fait 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail IM NA ❑Pass ❑Fail ®NA Vent Piping Containment Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Communication Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Vapor Recovery Piping Containment Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Communication Test Result ❑Pass ❑Fail 0 NA ❑ Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass []Fall 0 NA Turbine I Product Piping Sump Tightness Test Result 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA Fill Riser Sump Tightness Test Result 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA is Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA VENT I TRANSITION SUMP ID: a b C d Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass [:]Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA UDC ID: 11/2 2314 3516 4718 Tightness Test Result ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA UDC ID: 59110 611112 713114 8 Tightness Test Result ❑Pass 0 Fail ❑NA 0 Pass ❑Fail ❑NA 0 Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA UDC ID: 9 10 11 12 Tightness Test Result ❑Pass [:]Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA All items marked"t=ail"or'NA"must be explained in their respective"COMMENTS"section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that tine secondary containment was 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 -6— CERS=CaIFbrnlaErr,AronmentW Reporting System,ID=Idertkation,UST=Underground Storage a Tark,ICC=Irrtmnational Code Council,NAW Not Applicable,UDC=Under- Dispenser riDispenser Coniahment