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SEP 2 8 2016 Secondary Containment Testing Report FotWIRONMENTAL HEALTH This form is intended for use by contractors performing periodic testing of UST secondary containment systDEPhhRW ENT appropriate pages ofthisfortn to report results for all components tested The completedform,written test procedures, and printouts,f fom tests(f applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. 4. FACILITY INFORMATION Facility Name: VANCO TRUCK PLAZA Date of Testing: 8/3/2016 Facility Address: 1033 W.CHARTER WAY I County SAN JOAQUIN Facility Contact: TERRY Phone: Date Local Agency Was Notified of Testing: Name of Local Agency Inspector(if present during testing): 5. TESTING CONTRACTOR INFORMATION Company Name: B.Z.Service Station Maintenance Technician Conducting Test: DAVID ROUSE Credentials: ®CSLB Licensed Contractor ❑SWRCB Licensed Tank Tester License Type: ICC I License Number:433159 Manufacturer Trainine Manufacturer Component(s) Date Training Expires INCON TS-STS 9/1/2016 6. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component Pass Fail Not Repairs Tested Made Tested Made OCT. 100 STP Ll El I OCT. 100 FILL 87 STP 87 FILL 91 STP 91 FILL DSL i STPLj DSL 1 FILL DSL 2 STP DSL 2 FILL21 OCT. 100 SEC PROD TRANS/FILTER SUMP 87 SEC PROD LJ1 Lj 71 TRANS/FILTER SEC 91 SEC PROD 17, El I El OCT. 100 ANNULAR DSL 1 SEC PROD 87 ANNULAR DSL 2 SEC PROD 91 ANNULAR DSL SYPHON SEC DSL 1 ANNULAR DSL 2ANNULAR Lj Ifhydrostatic testing was performed,describe what was done with the water after completion of tests: TOOK AS TEST WATER CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge,the facts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: Date: 8/3/2016 Secondary Containment Test Results 2 of 15