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SWRCB,January 2002 Page 1. s Second g P Containment Testing Re •t Form This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this form to report results for all components tested. The completed form, written test procedures, and printouts from tests(if applicable),should be provided to the facility owner/operator for submittal to the local regulatory agency. 1. FACILITY INFORMATION FacilityName: CONOCO PHILLIPS #2708671 Date of Testing: 09/04/2007 Facility Address: 8606 THORNTON ROAD STOCKTON, CA, 95209 Facility Contact: MANAGER Phone: (2 0 9) 478-8959 Date Local Agency Was Notified of Testing Name of Local Agency Inspector(if present during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: TANKNOLOGY, INC. Technician Conducting Test: MATTHEW HASLEY Credentials: CSLB Licensed Contractor SWRCB Licensed Tank Tester License Type.. License Number: Manufacturer Training Manufacturer Component(s) Date Training Expires tanknology all 05/29/2009 3. SUMMARY OF TEST RESULTS Not Repairs Not Repair Component Pass Fail Tested Made Component Pass Fail Tested M ade Tank Annular 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Tank Annular 2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Tank Annular 3 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Secondary Pipe 1 sup ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Secondary Pipe 2 plus E ❑ ❑ ❑ ❑ ❑ ❑ El Secondary Pipe 3 reg X ❑ ❑ ❑ ❑ ❑ ❑ ❑ Piping Sump 1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ Piping Sump 2 X ❑ ❑ ❑ ❑ ❑ ❑ El- Piping Piping Sump 3 El ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC 1/2 ❑ ❑ ❑ ❑ ❑ ❑ ❑ UDC 3/4 ❑ ❑ ❑ ❑ ❑ ❑ El- El El El El E El E If hydrostatic testing was performed,describe what was done with the water after completion of tests: site to site 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: ;oo Date: 09/04/2007