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SECONDARY CONTAINMENT TESTING ffW;PORT FORM <br />TESTING DATE: APRIL 1, 2002 <br />1. <br />OWNER INFORMATION <br />--ALTH <br />Number of Tanks Tested <br />Number of Piping Sumps Tested <br />Name Quik Stop Markets <br />Contact Michael Karvelot <br />Phone # <br />(510) 657-8500 <br />Pass Fail <br />Address 4567 Enterprise Street, Fremont, CA 94538 <br />Annular - Tank #1 <br />Gasoline - 91 <br />.............. I-- - <br />................. ........... . .... ... ................... <br />N/A - Brine filled annulars <br />......... ---------- <br />......................................... <br />Gasoline - 87 <br />.......... ............................ ...... ....... <br />.................. ........ - .............. . ........ - ................ ......... .............. ............ <br />........... ............. ........... ........ ........ -1 ........ ..................... <br />- ..... ... <br />......................................... <br />2. <br />FACILITY INFORMATION <br />Name Quik Stop #39 <br />Contact Michael Karvelot <br />Phone # <br />(510) 657-8500 <br />0 <br />Address 2285 E. Fremont St., Stockton, CA 95205 <br />Secondary Pipe #2 <br />............................................... <br />........... ............................ .. ........ ........ ..................... ................................... <br />..... - .............. ....... ........... -:- <br />........................... - .......... .... ............. <br />............ ...................................... ............... <br />....... <br />........ ....... ........ <br />................. <br />............... <br />...... ............ .............................. ............ <br />...... ...... ...... ............. <br />.................. I ...................... -- ................. ............. ......................................... <br />.................................................................... .............................. .................... ............ <br />- ............... - .... <br />....... ......... <br />.. ....... ..................... <br />...... .................. <br />3. <br />LOCAL AGENCY INFORMATION <br />Name San Joaquin County Environmental Health <br />Notified <br />March 29, 2002 <br />0 <br />Contact Tank Team <br />Phone # <br />(209) 468-9847 <br />Gasoline - 87 <br />Address 304 E. Weber Ave., Stockton, CA 95202 <br />Fax # <br />(209) 468-3433 <br />Inspector Present <br />............. <br />...................... ...... ........ .......... <br />.............................. ............... ................ ................................ ................................. .................................... <br />...................... ....... <br />....... ............. <br />....... ........ ........ <br />...... - .......... ................ <br />............ <br />........ ...................... ....... - ............................... ....... ....... ...... <br />U D C #1 <br />Disp # 1/2 <br />4. <br />TESTING CONTRACTOR INFORMATION <br />U D C#2 <br />Disp # 3/4 <br />Name Walton Engineering, Inc. <br />Lic#/Ciass <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 James Day <br />.............. <br />...... . . . . ...... . . . . <br />-- .............................. ..... -- ....... .. ...... ........ <br />........................................... <br />5. SUMMARY OF TEST RESULTS <br />Number of Tanks Tested <br />Number of Piping Sumps Tested <br />0 <br />2 <br />Number of Piping Runs Tested 2 <br />Number of UDC Boxes Tested 2 <br />Component <br />Pass Fail <br />Comments <br />Annular - Tank #1 <br />Gasoline - 91 <br />N/A - Brine filled annulars <br />Annular - Tank #2 <br />Gasoline - 87 <br />Secondary Pipe #1 <br />Gasoline - 91 <br />0 <br />0 <br />Secondary Pipe #2 <br />Gasoline - 87 <br />0 <br />0 <br />Piping Sump #1 <br />Gasoline - 91 <br />0 <br />0 <br />Piping Sump #2 <br />Gasoline - 87 <br />0 <br />.0 <br />U D C #1 <br />Disp # 1/2 <br />0 <br />0 <br />U D C#2 <br />Disp # 3/4 <br />0 <br />0 <br />0 2002 <br />7C. <br />-)_ <br />(Y , ? — <br />/111� <br />Technician Signature Date <br />