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belshire 25971Towne centre Drive <br /> Foothill Ranch, CA 92610 <br /> environmental services, Inc. (949) 460-5200 <br /> Under Dispenser Containment Sump Integrity Testing <br /> Hydrostatic Testing Method <br /> Facility : Costco Wholesale - TRACY - 0658 Date : 9/24/2020 <br /> Address : 3250 W . Grantline Rd Testing Company : Belshire Environmental Services , Inc . <br /> City , State, Zip : Tracy , CA 95377 Tester Name : Jeff Badders <br /> This test is performed in accordance with PEI /RP1200 . See Section 6 . 5 for the test method and procedures . <br /> Containment Sump ID 1 /2 3/4 5/6 7/ 8 9/ 10 <br /> Exempt from Testing No No No No No <br /> Containment Sump <br /> manufacturer Environ Environ Environ Environ Environ <br /> Containment Sump <br /> material Plastic Plastic Plastic Plastic Plastic <br /> Liquid and debris <br /> removed from sump ? ' Yes Yes Yes Yes Yes <br /> Visual Inspection" Pass Pass Pass Pass Pass <br /> Containment Sump <br /> Depth 34" 34 34 34 34" <br /> Height From Bottom to <br /> Top of Highest <br /> Penetration <br /> Test Start Time 12 : 16 PM 12 : 16 PM 12 : 16 PM 11 : 53 AM <br /> Starting Water Level 4 . 1909 7 . 0492 3 . 9069 7 . 8917 <br /> Test End Time 12 : 31 PM 12 : 31 PM 12 : 31 PM 12 : 08 PM <br /> Ending Water Level 4 . 1547 7 . 0488 3 . 9068 7 . 8901 <br /> Nater Level Change - 0 . 0362 - 0 . 0004 - 0 . 0001 - 0 . 0016 <br /> Test Period 15 Minutes 15 Minutes 15 Minutes 15 Minutes 15 Minutes <br /> Pass/fail criteria : Must pass visual inspection . Water level drop of less than 0 . 002 inches . <br /> Test Results: D PaSSWd Fail FTP�assD Fail Cl Passel Fail WJ PassCO Fail A Passim Fail <br /> Comments : <br /> 1 /2 not tested due to bad test boots . <br /> -3/4 failed during testing . <br /> *All liquids and debris must be disposed of properly . <br /> # No cracks, loose parts or separation of the containment sump _ <br /> Technician Signature : > Mgr-(w. r-� Date : 9/24/2020 <br /> Rev . 9/28/2018 <br />