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-3� <br />Section VII <br />Underground Storage Tank <br />Secondary Containment Testing Report For i <br />TYPE OF ACTION ❑ Installation L-1 Repair [] 6 Month ® 36 Month <br />1_ FACILITY INFORMATION <br />CERS ID Test Date <br />1/15/2021 <br />Facility Name I <br />Kwik Sery Lodi <br />Facility Address i City �� -County- Zip Code <br />420 W Kettleman Lane 'Lodi San Joaquin ENV <br />SERVICE TECHNICIAN INFORMATION <br />_2. <br />Company Performing the Test Phone <br />BZ Service Station Maintenance 916-371-2380 <br />Mailing Address--__--�-_ - -------- _- - <br />1041 Triangle Ct., West Sacramento, CA 95826 <br />Contractor/Tank Teste7License— Number <br />433159 <br />Service Technician Performing Test <br />Jeff Raven <br />iCC Number I ICC Expiration Date <br />9326216 8/31/2021 <br />3. TRAINING AND CERTIFICATIONS <br />_ <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />Franklin Fueling INCON: 1016313710 <br />10/20/2022 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />_ <br />Components Tested <br />PEI/RP1200Nacuum Test/10Hg for 1hr <br />Annular: 2 annular -� <br />PEURP 1 200/Pressure Test/5 psi for 1 h <br />Piping: 2 sec lines <br />Sumps/UDCs: 2 UDC, 3 STP <br />INCON/TS1000/Hydrostatic -15min <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />/hereby certify that the secondary containment was tested in accordance with Ca//fomia Code of <br />Regulations, title 23, division 3, chapter 16, section 2367,• that required supporting documentation is <br />attached; and all information contained herein is accurate. / understand that test procedures shall <br />be made available upon est by the governing authority. <br />Se i echniciao,,5ignature <br />Date <br />Total # of Pages <br />1/15/2021 <br />1U <br />Page 1 of 6 <br />