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SWRCB, January 2002 � RE G"E+VEB Secondary Containment Testing .Report Form MAY 18 2015 MID VALLEY CONSULTING �tvvlRon�iElurarrHEALTH AND GENERAL ENGINEERING 1097 BRONCO DRIVE, PLUMAS LAKE CA. 95961 (530) 749-9892 Ca Lie#. 920085 CL%IITISERVICES E-MAIL: midvalle.consultin@sbcglobal.net 1. FACILITY INFORMATION Facility Name: FAST AND EASY CHEVRON Date of Testing: 4/30/2015 Facility Address: 1.0878 N, HWY 99 STOCKTON CA, 95212 Facility Contact: MIKE ALI Rhone: Date Local Agency Was Notified of Testing: 4/26/2015 Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: Mid Valley Consulting Pass Technician Conducting Test: JAMES DAY Not Repairs Component Tested Made Credentials: CSLB Licensed Contractor Fail License Type: CLASS A License Number: 920985 Manufacturer Manufacturer Training Component(s) Date Training Expires INCON TS -STS 11/01/2015 X ❑ ❑ ❑ 9 1 /DIESEL ANNULAR X 3. SUMMARY OF TEST RESULTS Component Pass Fail Not Repairs Component Tested Made Pass Fail Not Tested Repairs Made 87 ANNULAR X ❑ ❑ ❑ DISP 5-6 X ❑ ❑ ❑ 9 1 /DIESEL ANNULAR X ❑ ❑ ❑ DISP 7-8 X ❑ ❑ ❑ 87 PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 T2 PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 T1 PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DIESEL PIPE SECONDARY X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 87 STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 T1 STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ 91 T2 STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DIESEL STP SUMP X ❑ ❑ ❑ ❑ ❑ ❑ ❑ DISP 1-2 X ❑❑ ❑ ❑ ❑ ❑ ❑ DISP 3-4 X ❑ ❑ ❑ ❑ ❑ ❑ ❑ If hydrostatic testing was performed, describe what was done with the water after completion of tests: Water will be removed from all tested containment sumps and filtered through a charcoal activated filtration system and returned to our on board storage Tank. CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING To the best of my knowledge, the fiacts stated in this document are accurate and in full compliance with legal requirements Technician's Signature: f Date : 4/30/2015