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SECONDARY CONTAINMENT TESTING - REPORT FORM <br /> TESTING DATE: APRIL 26, 2002 <br /> .... <br /> 1. OWNER INFORMATION <br /> Name Quik Stop Markets <br /> Contact Michael Karvelot Phone# (510) 657-8500 <br /> Address 4567 Enterprise Street, Fremont, CA 94538 <br /> ..... ..... .. <br /> 2. FACILITY INFORMATION <br /> Name Quik Stop#144 <br /> Contact Michael Karvelot Phone# (510) 657-8500 <br /> Address 7272 West Lane, Stockton, CA 95209 <br /> «.... . <br /> 3. LOCAL AGENCY INFORMATION <br /> Name San Joaquin County Environmental Health Notified March 29, 2002 <br /> Contact Tank Team Phone# (209) 468-9847 <br /> Address 304 E. Weber Ave., Stockton, CA 95202 <br /> Inspector Present <br /> _. -. _ ... <br /> 4. TESTING CONTRACTOR INFORMATION <br /> Name Walton Engineering, Inc. Lic#/Class 617238 A, B, Haz <br /> Contact Michael Walton Phone# (916) 373-1152 <br /> Address P.O. Box 1025, West Sacramento, CA 95691 <br /> Test Technician David D ess <br /> 5. SUMMARY OF TEST RESULTS <br /> Number of Tanks Tested 3 Number of Piping Runs Tested 3 <br /> Number of Piping Sumps Tested 3 Number of UDC Boxes Tested 3 <br /> Component Pass Fail Comments <br /> Annular-Tank#1 Gasoline-87 • O ,`s <br /> Annular-Tank#2 Gasoline-89 • O <br /> Annular-Tank#3 Gasoline-91 • O <br /> cx <br /> Secondary Pipe#1 Gasoline-87 • O <br /> Secondary Pipe#2 Gasoline-89 • O r <br /> Secondary Pipe#3 Gasoline-91 • O <br /> Piping Sump#1 Gasoline-87 • O <br /> Piping Sump#2 Gasoline-89 • O <br /> Piping Sump#3 Gasoline-91 • O <br /> U D C#1 Disp#1/2 • O <br /> U D C#2 Disp#3/4 • O <br /> U D C#3 Disp#5/6 • O <br /> __... _. <br /> © 2002 Walton Engineering,Inc. 7 <br /> Technician Signature ✓ � " Date <br /> �� <br />