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All lda� <br /> SECONDARY CONTAINMENT TESTING - REPO T FORM <br /> TESTING DATE: November 20, 200 <br /> 1. OWNER INFORMATION <br /> Name Quik Stop Markets y <br /> Address 4567 Enterprise Street, Fremont, CA 94538 �`1w PhoMO440-657-8500 <br /> Contact Michael Karvelot -:, i+ ``' ES <br /> 2. FACILITY INFORMATION <br /> Name Quik Stop#152 <br /> Address 1721-1 S. Cherokee Lane, Lodi, CA 95240 Phone# 510-657-8500 <br /> Contact Michael Karvelot <br /> 3. LOCAL AGENCY INFORMATION <br /> Name San Joaquin County Environmental Health Notified November 17, 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 No <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 Phillip Klin man <br /> 5. SUMMARY OF TEST RESULTS <br /> Number of Tank Annulars 3 Number of Spill Containers 3 <br /> Number of Secondary Lines 3 Number of UDC's Tested 2 <br /> Number of Piping Sumps 3 <br /> Component Pass Fail Component Pass Fail <br /> Annular-Tank#1 Gasoline-87 • Spill Container#1 Gasoline-87 • <br /> Annular-Tank#2 Gasoline-89 • Spill Container#2 Gasoline-89 • <br /> Annular-Tank#3 Gasoline-91 • Spill Container#3 Gasoline-91 • <br /> Secondary Line#1 Gasoline-87 • U D C#1 Disp#112 • <br /> Secondary Line#2 Gasoline-89 • U D C#2 Disp#314 • <br /> Secondary Line#3 Gasoline-91 • <br /> Piping Sump#1 Gasoline-87 • <br /> Piping Sump#2 Gasoline-89 • <br /> Piping Sump#3 Gasoline-91 1 • <br /> 6. COMMENTS <br /> This is a tri-annual full secondary test. <br /> This facility was originally tested on March 7, 2002. <br /> Technician Signature Date <br /> © 2003 Watton Engineering,Inc. <br />