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1 <br /> SECONDARY TAI I - REPORT FORM <br /> RETEST DATE: MAY 3, 2002 <br /> .;:.;:..::.:...... .................................................... <br /> ................... <br /> 1. OWNER INFORMATION <br /> Name Quik Stop Markets <br /> Contact Michael Karvelot Phone# (510) 657-8500 <br /> Address 4567 Enterprise Street, Fremont, CA 94538 <br /> .:::..::..:.:.:: .............::..::::..::.:::::.:::........ . <br /> 2. FACILITY INFORMATION <br /> Name Quik Stop#152 <br /> Contact Michael Karvelot Phone# (510) 657-8500 <br /> Address 1721-1 So. Cherokee, Lodi CA 95240 <br /> 3. LOCAL AGENCY INFORMATION <br /> Name San Joaquin County Environmental Health Notified April 25, 2002 <br /> Contact Tank Team Phone# (209) 468-9847 <br /> Address 304 E. Weber Ave., Stockton, CA 95202 Fax# (209) 468-3433 <br /> Inspector Present <br /> ..... . ........ ............:.....................::...................................:................ .............................:. ... <br /> 4. TESTING CONTRACTOR INFORMATION <br /> Name Walton Engineering, Inc. Lic#/Class 617238 A, B, Haz <br /> Contact Michael Walton Phone# (916) 373-1152 <br /> Address P.O. Box 1025, West Sacramento, CA 95691 <br /> Test Technician James Da <br /> ...........:::.:::.....:::::::.....::..::.::..............:.::::::........::::::..............................:.....,..:..:.,..:,..:::::::.......... <br /> 5. SUMMARY OF TEST RESULTS <br /> Number of Tanks Tested 0 Number of Piping Runs Tested 0 <br /> Number of Piping Sumps Tested 3 Number of UDC Boxes Tested 0 <br /> Component Pass Fail Comments <br /> Annular-Tank#1 Gasoline-87 <br /> Annular-Tank#2 Gasoline-89 <br /> Annular-Tank#3 Gasoline-91 <br /> Secondary Pipe#1 Gasoline-87 <br /> Secondary Pipe#2 Gasoline-89 <br /> Secondary Pipe#3 Gasoline-91 <br /> Piping Sump#1 Gasoline-87 • O This is a retest of sumps only <br /> Piping Sump#2 Gasoline-89 • O This site was originally tested on March 7,2002 <br /> Piping Sump#3 Gasoline-91 • O <br /> U D C#1 Disp#1/2 <br /> U D C#2 Disp#3/4 <br /> C t. <br /> ........... . <br /> .. <br /> © 2002 Walton Engineering,Inc. <br /> Technician Signature ,✓` �✓ f Date j <br />