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SECONDARY CONTAINMENT TESTING = REPORT FORM <br />TESTING DATE: Augu 't . .',-r % IIn t- l_ i } 1 <br />1. OWNER INFORMATION <br />Name Quik Stop Markets 03 AUG 19 AM 11: 57 <br />Address 4567 Enterprise Street, Fremont, CA 94538 Phone # 510-657-8500 <br />Contact Michael Karvelot <br />2. FACILITY INFORMATION <br />Name Quik Stop #148 <br />Address 205 W. Lockeford Street, Lodi, CA 95240 Phone # 510-657-8500 <br />contact Michael Karvelot <br />3. LOCAL AGENCY INFORMATION <br />Name San Joaquin County Environmental Health Notified August 11, 2003 <br />Address 304 E. Weber Ave., Stockton, CA 95202 Phone # 209-468-9847 <br />Contact UST Team Fax# 209-468-3433 <br />Inspector Present None <br />4. TESTING CONTRACTOR INFORMATION <br />Name Walton Engineering, Inc. Lic# 617238 A, B, Haz <br />contact Michael Walton Phone # 916-373-1152 <br />Address P.O. Box 1025, West Sacramento, CA 95691 Fax # 916-373-1172 <br />Test Technician Richard Walton <br />5. SUMMARY OF TEST RESULTS <br />Number of Tank Annulars 0 <br />Number of Secondary Lines 0 <br />Number of Piping Sumps 0 <br />Number of Spill Containers <br />Number of UDC's Tested <br />3 <br />0 <br />Component <br />Pass Fail <br />Component <br />Pass Fail <br />Annular - Tank #1 <br />Gasoline - 87 <br />Spill Container #1 <br />Gasoline - 87 <br />• <br />Annular - Tank #2 <br />Gasoline - 89 <br />Spill Container #2 <br />Gasoline - 89 <br />• <br />Annular - Tank #3 <br />Gasoline - 91 <br />Spill Container #3 <br />Gasoline - 91 <br />• <br />Secondary Line #1 <br />Gasoline - 87 <br />U D C #1 <br />Disp # 1/2 <br />Secondary Line #2 <br />Gasoline - 89 <br />U D C #2 <br />Disp # 3/4 <br />Secondary Line #3 <br />Gasoline - 91 <br />Piping Sump #1 <br />Gasoline - 87 <br />Piping Sump #2 <br />Gasoline - 89 <br />Piping Sump #3 <br />Gasoline - 91 <br />6. COMMENTS <br />This is an annual test of spill containers only. <br />Technician Signature L�/ Date <br />0 2003 Walton Engineering, Inc. <br />