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• RECEO'1 OD <br /> P.O.Box 4208 <br /> JUL 0 2 2018 Sonora 4195370 <br /> AlitechPetr • Phone: <br /> 209-53 -7320 <br /> ENVIRONMENTAL HEALTH Phone:209-532-7320 <br /> Compliance without Compromise PERMMSERVCEs Fax:209-533-2650 <br /> mail@alltechpetro.com <br /> www.alitechpetro.com <br /> Secondary Containment Testing Report Form <br /> This form is intended for use by contractors performing periodic testing of UST secondary containment systems. Use the appropriate pages of this <br /> form to report results for all components tested. The completed form, written test procedures,and printouts from tests(if applicable),should be <br /> provided to the facility owner/operator for submittal to the local regulatory agency. <br /> 1. FACILITY INFORMATION <br /> Facility Name: Hammer 1-5 Arco Date of Testing: 5/24/18 <br /> Facility Address: 3201 W. Hammer Lane Stockton CA <br /> Facility Contact: Wes Parkinson Phone: (209) 474-9125 <br /> Date Local Agency Was Notified of Testing : 5/16/18 <br /> Name of Local Agency Inspector (if present during testing): Aaron Hang <br /> 2. TESTING CONTRACTOR INFORMATION <br /> Company Name: Alltech Petro Inc. <br /> Technician Conducting Test: Chad White <br /> Credentials: ® CSLB Licensed Contractor NSWRCB Licensed Tank Tester <br /> License Type: A-Haz License Number: 623541 A-haz <br /> Manufacturer Training <br /> Manufacturer Component(s) Date Training Expires <br /> Caldwell Sump Tester 04-13-20 <br /> 3. SUMMARY OF TEST RESULTS <br /> Component Pass Fail Not Repairs Component Pass Fail Not Repairs <br /> Tested Made Tested Made <br /> 87 Master Turbine Sump ® ❑ ❑ ❑ vapor Transition Sump ® ❑ ❑ ❑ <br /> 87 Syphon Piping Sump ® ❑ ❑ ❑ PipingTransition Sump ® ❑ ❑ ❑ <br /> 91 Turbine Sump ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> ❑ I ❑ I ❑ ❑ Vapor Pot evac chase line ® ❑ ❑ ❑ <br /> UDC 1/2 ® ❑ ❑ ❑ 87 Syphon Line ® ❑ ❑ ❑ <br /> UDC 3/4 ® ❑ ❑ ❑ ❑ ❑ ❑ ❑ <br /> UDC 5/6 ® ❑ ❑ ❑ 87 Master Annular ® ❑ ❑ ❑ <br /> UDC 7/8 ® ❑ ❑ ❑ 87 Syphon Annular ® ❑ ❑ ❑ <br /> ❑ ❑ ❑ ❑ 91 Annular N . ❑ ❑ ❑ <br /> 87 Product Line I ® I ❑ ❑ ❑ ❑ ❑ ❑ I ❑ <br /> 91 Product Line I ® ❑ ❑ Q-1 ❑ I ❑ ❑ I ❑ <br /> If hydrostatic testing was performed, describe what was done with the water after <br /> completion of tests: <br /> Testing water stored in barrels onsite <br /> CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br /> To the best of my knowledge, the facts stated in this document are accurate and in full compliance with legal requirements <br /> Technician's Signature: Date: 05/24/18 <br />