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a 4P T <br />SECONDARY CONTAINMENT TESTING - REPORT FORM <br />RETESTING DATE: MAY 14, 2002 <br />1. <br />OWNER INFORMATION <br />Number of Tanks Tested <br />Number of Piping Sumps Tested <br />0 <br />3 <br />Name Quik Stop Markets <br />Number of Piping Runs Tested 0 <br />Number of UDC Boxes Tested 0 <br />Component <br />Contact Michael Karvelot <br />Phone # <br />(510) 657-8500 <br />Gasoline - 87 <br />Address 4567 Enterprise Street, Fremont, CA 94538 <br />Annular - Tank #2 <br />Gasoline - 89 <br />Annular - Tank #3 <br />Gasoline - 91 <br />... .. .. ......... .. ........... ...... ........... ..................................... <br />.... <br />2. <br />FACILITY INFORMATION <br />Secondary Pipe #1 <br />Gasoline - 87 <br />Name Quik Stop #132 <br />Secondary Pipe #2 <br />Gasoline - 89 <br />Contact Michael Karvelot <br />Phone # <br />(510) 657-8500 <br />Gasoline - 91 <br />Address3555 W. Hammer Ln., Stockton, CA 95209 <br />Piping Sump #1 <br />Gasoline - 87 <br />...... ...... <br />This is a retest of these sumps only. <br />Piping Sump #2 <br />3. <br />LOCAL AGENCY INFORMATION <br />This site was originally tested on April 8, 2002 <br />Piping Sump #3 <br />Gasoline - 91 <br />Name San Joaquin County Environmental Health <br />Notified <br />May 6, 2002 <br />Contact Tank Team <br />Phone # <br />(209) 468-9847 <br />Disp # 1/2 <br />Address 304 E. Weber Ave., Stockton, CA 95202 <br />Fax: <br />(209) 468-3433 <br />Disp # 3/4 <br />Inspector Present <br />U D C #3 <br />Disp # 5/6 <br />U D C #4 <br />Disp # 7/8 <br />4. <br />TESTING CONTRACTOR INFORMATION <br />Name Walton Engineering, Inc. <br />t.ic#/Class <br />617238 A, B, Haz <br />Contact Michael Walton <br />Phone # <br />(916) 373-1152 <br />Address P.O. Box 1025, West Sacramento, CA 95691 <br />Test Technician David Dyess <br />5. SUMMARY OF TEST RESULTS <br />Number of Tanks Tested <br />Number of Piping Sumps Tested <br />0 <br />3 <br />Number of Piping Runs Tested 0 <br />Number of UDC Boxes Tested 0 <br />Component <br />Pass Fail <br />Comments <br />Annular - Tank #1 <br />Gasoline - 87 <br />Annular - Tank #2 <br />Gasoline - 89 <br />Annular - Tank #3 <br />Gasoline - 91 <br />Secondary Pipe #1 <br />Gasoline - 87 <br />Secondary Pipe #2 <br />Gasoline - 89 <br />Secondary Pipe #3 <br />Gasoline - 91 <br />Piping Sump #1 <br />Gasoline - 87 <br />• O <br />This is a retest of these sumps only. <br />Piping Sump #2 <br />Gasoline - 89 <br />0 O <br />This site was originally tested on April 8, 2002 <br />Piping Sump #3 <br />Gasoline - 91 <br />• O <br />U D C #1 <br />Disp # 1/2 <br />U D C #2 <br />Disp # 3/4 <br />U D C #3 <br />Disp # 5/6 <br />U D C #4 <br />Disp # 7/8 <br />1 <br />Technician Signature <br />Date <br />