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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 1 of 6) Type of Action 9 Installation Test 0 Repair Test ❑ Six Month Test © 36 Month Test I . FACILITY INFORMATION CERS ID Date of Secondary Containment Test 6121 /2019 Business Name (same as Facility Name or DBA-Doing Business As) Dart Container Business Site Address City ZIP Code 1400 E . Victor Road Lodi 95240 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification) Phone # David Rouse ( 925 ) 551 -7555 Contractor i Tank Tester License # ICC Certification # ICC Certification Expiration Date 220793 8292530 6/25/2020 III . SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID: (By tank number, stored product, etc.) A Diesel B C D Tank Containment Tightness Test Result EI Pass ❑ Fail D NA ❑ Pass ❑ Fail ❑ NA D Pass D Fail D NA D Pass D Fail ❑ NA Product Piping Containment Tightness Test Result D Pass ❑ Fail ❑ NA D Pass D Fail D NA ❑ Pass ❑ Fail ❑ NA D Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass D Fail ❑ NA ❑ Pass ❑ Fail D NA D Pass ❑ Fail D NA Remote Fill Piping Containment Tightness Test Result ❑ Pass D Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass D Fail ❑ NA Communication Test Result D Pass ❑ Fail ❑ NA D Pass ❑ Fail D NA ❑ Pass ❑ Fail ❑ NA D Pass ❑ Fail D NA Vent Piping Containment Tightness Test Result ❑ Pass D Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA D Pass D Fail DNA Communication Test Result ❑ Pass ❑ Fail ❑ NA D Pass D Fail p NA ❑ Pass D Fail D NA D Pass ❑ Fail D NA - -Vapor Recovery Piping Containment Tightness Test Result ❑ Pass D Fait ❑ NA D Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail D NA D Pass ❑ Fail D NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Turbine ! Product Piping Sump Tightness Test Result ❑ Pass ❑ Fail D NA ❑ Pass ❑ Fail ❑ NA ❑ Pass D Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result ❑ Pass D Fail ❑ NA D Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass D Fail ❑ NA VENT l TRANSITION SUMP ID: a b C d Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fall ❑ NA UDC tD: 1 2 3 4 Tightness Test Result ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail D NA D Pass ❑ Fail O NA ❑ Pass ❑ Fail ❑ NA UDC ID : 5 6 7 8 Tightness Test Result ❑ Pass D Fail D NA ❑ Pass ❑ Fail ❑ NAI ❑ Pass D Fail D NA ❑ Pass ❑ Fail ❑ NA UDC ID: 9 10 11 12 Tightness Test Result ❑ Pass D Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass D Fail ❑ NA D Pass D Fail D NA AM Items marked "Fail" or "NA " must be explained In their respective "COMMENTS " section. N. 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 info tion drAtained herein is accurate. UST Service Technician Signature jCERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council, NA ~ Not Applicable, UDC = Under- €( D isperw Contaimient