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f � <br /> SECONDARY CONTAINMENT TESTING - REPORT FORM <br /> ��.[. <br /> TESTING DATE: August 22, 2003 c NEAT_Tf1 <br /> 1. OWNER INFORMATION 03 AUG 27 PM 1: 35 <br /> Name Quik Stop Markets <br /> Address 4567 Enterprise Street, Fremont, CA 94538 Phone# 510-657-8500 <br /> Contact Michael Karvelot <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 August 18, 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 Number of Spill Containers 3 <br /> Number of Secondary Lines 0 Number of UDC's Tested 0 <br /> Number of Piping Sumps 0 <br /> Component Passl Fail I 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#1/2 <br /> Secondary Line#2 Gasoline-89 U D C#2 Disp#3/4 <br /> Secondary Line#3 Gasoline-91 <br /> Piping Sump#1 Gasoline-87 <br /> Piping Sump#2 Gasoline-89 <br /> Piping Sump#3 Gasoline-91 <br /> 6. COMMENTS <br /> This is an annual test of spill containers only. <br /> Technician Signature Date L,;?,j-ZO <br /> © 2003 Walton Engineering,Inc. <br />