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1. FACILITY INFORMATION Facility Name: Shell/Tesoro # 68153 1 Date of Testing: 1/22/14 Facility Address: 2448 W Kettleman Ln. — Lodi CA 95242 Facility Contact: _ Phone: (209) 369-3124 Date Local Agency Was Notified of Testing: 1/8/14 SB989-3yr. Compliance Test Name of local Agency Inspector (ifpresent during tesiing): 2. TESTING CONTRACTOR INFORMATION Company Name: ABLE Maintenance, Inc. Technician Conducting Test: James Moore / I.C.C. #5254517 -UT Credentials ® CSLB Licensed Contractor E SWRCB Licensed Tank'Fester i License Type: A, B, Haz., C10 license Number: 312844 y Manufacturer Training Manufacturer _ _ Component(s) Date Training Expires Available upon request ❑D 3. SUMMARY OF TEST RESULTS Component: Pass Fail Not Repairs Tested Made; Component: Pass Fail Not Repairs Tested .11ade 87 Tank Annular © ❑ ❑ ❑ 91 Fill Sum ❑D V ❑ ❑ ❑ 91 Tank Annular © ❑ ❑ ❑ Diesel Fill Sump ® ❑ ❑ i ❑ Diesel Tank Annular © ❑ j ❑ ❑ 87 Fill Bucket ❑ ❑ ❑ 87 Secondary Product M ❑ ❑ ❑ 91 Fill Bucket © ❑ ❑ ❑ 91 Secondary Product O G ❑ ❑ Diesel Fill Bucket M ❑ ❑ ❑ Diesel Secondary Product ® ❑ ❑ ❑ 87 Vapor Bucket OO a ❑ ❑ 87 Turbine Sump M ❑ ❑❑ - 91 VaporBucketM - ❑ 11 w-- 91 Turbine Sump M ❑ ❑ ❑ Diesel Turbine Sump M ❑ ❑ ❑ UDC 1/2 ® ❑ ❑ ❑ UDC 3/4 M ❑ ❑ ❑ UDC 5/6 M ❑ ❑ ❑ UDC 7/8 M ❑ ❑ ❑ 87 Fill Sump M ❑ ' ❑ 0 If hydrostatic testing was performed, describe what was done with the water after completion of tests: Used pump test truck