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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPOR RM ( Page 1 of 6 ) Type of Action ❑ Installation Test Rep81r Test , t4 ��, ii -Six ` onth Test 0 36 Month Test s I . I + f y INO'bAMATION CERS ID �y ZC Dale of Secondary Containment Test 10181249 tllA 1 /31 /2019 Business Name (Same as Facility Name or DBA- Doing Business As) ARP Mini Mart Mobil ��(' f\.4. Business Site Address �� oj ZIP Code 25775 S . Patterson Pass Rd . }� ` Tracy 95376 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification. ) one # Guadalupe Sanchez ( 925 ) 470 - 0803 Ext . Contractor/Tank Tester License # ICC Certification # ICC Certification Expiration Date 1005444 5250451 4/8/2019 III , SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS Tank ID : (By tank number, stored product, etc.) A T1 : 87 B T2 : 87 Master C T3 : Diesel D T4 : 91 Slave/Syphon 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 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Vent Piping Containment Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Turbine / 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 ❑x Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA Vent / Transition Sump ID : a b C d Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 1 1 & 2 2 3 &4 35 &6 47 & 8 Tightness Test Result 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA UDC ID : 5 6 7 8 Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 9 10 11 112 Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA All items marked "Fail " or "N/A " must be explained in their respective "COMMENTS " section . IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the 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 C::; CERS = California Environmental Reporting System , ID = Identification UST = Underground storage tank , ICC = International Code Council , NA = Nnt nnnrirahly I Inn = I I nrlar_Aicnancnr rnntaimmPnt