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Incomplete Test Results Received by EHD (EF) on 12/16/2021 1 i UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 1 of 6) Type of Action ❑ Installation Test ❑Repair Test E]Six Month Test 2136 Month Test I. FACILITY INFORMATION CERS101 ID Date of Secondary Containment Test 1 Q180877 8/5/2020 Business Name(Same as Facility Name or DBA-Doing Business As) Western Food & Fuel Business Site Address City ZIP Code 3032 East Waterloo Road Stockton 95205 11, UNDERGROUND STORAGE TANK SERVICE TECHNICIAN_ INFORMATION Name of UST Service Technician Performing the Test(Print as shown on the/CC Certification) Phone# Benjamin Duncan (707) 621-0378 Contractor/Tank Tester License# ICC Certification# ICC Certification Expiration Date Tank Tester License #90-1120 5246802-UT 3/21/2021 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID:(By tank number,stored product,etc.) A T-1-Regular 87 B T-2-Super 91 C T-3-Diesel D Tank Containment i Tightness Test Result 0 Pass ❑Fail ❑NA Z Pass ❑Fail ❑NA Z Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Product Piping Containment Tightness Test Result Z Pass ❑ Fail ❑NA Z Pass ❑ Fail ❑NA Z Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Communication Test Result Z Pass ❑Fail ❑NA ®Pass ❑ Fail ❑NA Z Pass [:3 ail ❑NA ❑Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑Pass ❑Fail Z NAI ❑Pass ❑Fail 2 NA ❑Pass ❑Fail Z NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail Z NA ❑Pass ❑Fail 2 NA ❑Pass ❑Fail Z NA ❑Pass ❑ Fail ❑NA Vent Piping Containment Tightness Test Result ❑Pass ❑ Fail Z NA ❑Pass ❑ Fail Z NA ❑Pass ❑Fail ®11 NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑ Fail 10 NA ❑Pass E] Fail Z NA [Il 2 Pass ❑ FaiNA ❑Pass ElFail ❑NA Vapor Recovery Piping Containment Tightness Test Result ❑Pass ❑ Fall ®NA ❑Pass ❑ Fail Z NA ❑Pass ❑Fail Z NA 0 Pass ❑ Fail ❑NA Communication Test Result ❑Pass ❑Fail IM NA ❑Pass ❑Fail ®NA ❑Pass ❑Fail Z NA ❑Pass ❑Fail ❑ NA Turbine/Product Piping Sump Tightness Test Result Z Pass ❑ Fail ❑NA ®Pass ❑ Fail ❑NA Z Pass ❑ Fail Q NA ❑Pass ❑Fail ❑NA Fill Riser Sump Tightness Test Result ❑Pass ❑ Fail B NA ❑Pass ❑ Fail Z NA ❑Pass ❑ Fail Z NA ❑ Pass ❑ Fail ❑NA VENT/TRANSITION SUMP ID: a b C d Tightness Test Result C7 Pass ❑ Fail Z NA ❑Pass ❑ Fall Z NA ❑Pass ❑ Fall Z NA ❑Pass ❑ Fail ❑NA UDC ID: 1 1&2 2 3&4 3 5&6 4 Tightness Test Result Z Pass ❑Fail ❑NA Z Pass ❑ Fail ❑NA Z Pass ❑Fail ❑NA ❑Pass ❑Fall ❑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 12 Tightness Test Result 10 Pass ❑Fail p 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 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 �/�f' <<0��iCL1�^Z{y!i �e!/tl9tCafY� CERS=Califomia Environmental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Council,NA=Not Applicable,UDC=Under- Dispenser Containment