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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page t of 6) Type of Action ❑ Installation Test ❑Repair Test ❑Six Month Test E 36 Month Test I. FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10156057 07-15-2020 Business Name(Same as Facility Name or DBA-Doing Business As) UPS Business Site Address City ZIP Code 1532 North Broadway. Stockton 195205 11. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test(Print as shown on the ICC Certification.) Phone# David Pereira (510)880 - 0008 Ext. Contractor/Tank Tester License# ICC Certification# ICC Certification Expiration Date 415807 5240739-UT 8-31-2020 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS Tank ID: (By tank number,stored product,etc.) A T-1 B C D Tank Containment Tightness Test Result ❑ Pass ❑Fail E NA ❑ Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail ❑NA Product Piping Containment Tightness Test Result E Pass ❑Fail ❑ NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑ Fail ❑NA ❑Pass ❑ Fail ❑NA Communication Test Result ❑ Pass ❑ Fail E NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail E NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑ Fail ❑NA ❑Pass ❑ Fail ❑NA Communication Test Result ❑Pass ❑ Fail El NA ❑Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑NA ❑Pass ❑Fail [INA Vent Piping Containment Tightness Test Result ❑ Pass ❑Fail M NA ❑ Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail E NA ❑ Pass ❑ Fail ❑ NA ❑Pass ❑ Fail ❑ NA ❑ Pass ❑Fail ❑NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail E NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail ❑NA ❑ Pass ❑ Fail ❑NA Communication Test Result ❑Pass ❑ Fail E NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑ NA Turbine I Product Piping Sump Tightness Test Result E Pass ❑Fail ❑NA ❑ Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑ NA ❑ Pass ❑Fail ❑NA Fill Riser Sump Tightness Test Result ❑ Pass ❑Fail El NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Vent I Transition Sump ID: a b C Tightness Test Result ❑Pass ❑ Fail E NA ❑Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑NA ❑Pass ❑ Fail ❑ NA UDC ID: 1 # 1-2 Diesel 2 3 Tightness Test Result E Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑NA ❑Pass ❑Fail ❑ NA ❑Pass ❑Fail ❑NA UDC ID: 5 Tightness Test Result ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail [:1 NAE] Pass [:1Fail [-INA ElPass ElFail ❑ NA UDC ID: 9 110 11 12 Tightness Test Result ❑Pass ElFail [INA I[IPass [IFail ElNA ❑ Pass ❑ Fail ❑ NA I ❑Pass ❑Fail ❑ NA All items marked"Fail"or WA"must be explained in their respective"COMMENTS"section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING 1 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 Sig natur��-"-. CERS=California Environmental Reporting System,ID=Identification,UST=Underground storage tank,ICC=International Code Council, NA=Not applicable,UDC=Under-dispenser containment