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REG"'EIVED FEB 0 3 2017 ENVIRONMENTAL HEALTH 1. FACILITY INFORMATION rNr-mAOTAAPNT Facility Name: Shell/Tesoro # 68153 Date of Testing: 1/3/17 Facility Address: 2448 W Kettleman Ln. — Lodi CA 95242 Facility Contact: Grace Kelly Phone: (209) 369-3124 Date Local Agency Was Notified of Testing; 12/27/16 SB989 — 3yr. Compliance Test Name of Local Agency Inspector (ifpresent during testing): 2. TESTING CONTRACTOR INFORMATION Company Name: ABLE Maintenance, Inc. Technician Conducting Test: Shaun Malone/ I.C.C. #8320932 Credentials: ® CSLB Licensed Contractor ❑ SWRCB Licensed Tank Tester License Type: A, B, Haz., C10 License Number: 312844 Manufacturer Training Manufacturer Component(s) Date Training Expires Available upon request 3. SUMMARY OF TEST RESULTS Component: Pass Fail Not Repairs Tested Made Component: Pass Fail Not Repairs Tested Made 87 Tank Annular ® ❑ ❑ ❑ 91 Fill Sump ® ❑ ❑ ❑ 91 Tank Annular © ❑ El [IDiesel Fill Sump ❑ ❑ ❑ Diesel Tank Annular ® ❑ ❑ ❑ 87 Fill Bucket © ❑ ❑ ❑ 87 Secondary Product © ❑ ❑ ❑ 91 Fill Bucket ® ❑ ❑ ❑ 91 Secondary Product ® ❑ ❑ ❑ Diesel Fill Bucket ® ❑ ❑ ❑ Diesel Secondary Product D ❑ ❑ ❑ 87 Vapor Bucket ® ❑ ❑ ❑ 87 Turbine Sump ® ❑ ❑ ❑ 91 Vapor Bucket ® ❑ ❑ ❑ 91 Turbine Sump ® ❑ ❑ Diesel Turbine Sump El ❑ I ❑ 0 UDC 1/2 © ❑ ❑ ❑ L— UDC 3/4 ® ❑ ❑ ❑ UDC 5/6 © ❑ ❑ ❑ UDC 7/8 ® ❑ ❑ ❑ 87 Fill Sump © ❑ ❑ ❑ i If hydrostatic testing was performed, describe what was done with the water after completion of tests: Used pump test truck