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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 1 of 6) Type of Action ❑Installation Test ❑x Repair Test ❑Six Month Test ❑36 Month Test I. FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10181579 4/17/2019 Business Name(Same as Facility Name or DBA-Doing Business As) Tracy Unified School District-Trac USD-Service Center Business Site Address City ZIP Code 1975 W Lowell Avenue Tracy 195376 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test(Print as shown on the ICC Certification) Phone# Benjamin Duncan (707) 621-0378 Contractor/Tank Tester License# ICC Certification# ICC Certification Expiration Date Afford-a-test/90-1120 5246802-UT 3/20/2021 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID:(By tank number, stored product, etc.) A T-1-Regular 87 B T-2-Diesel Fuel C D Tank Containment Tightness Test Result ❑ Pass ❑ Fail O NA Z Pass ❑ Fail ❑NA ❑ Pass ❑Fail ❑NA ❑ Pass ❑Fail ❑NA Product Piping Containment Tightness Test Result ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA ❑Pass ❑Fail ❑NA ❑ Pass ❑Fail ❑ NA Communication Test Result ❑Pass ❑Fail E NA ❑ Pass ❑Fail O NA ❑Pass ❑Fail ❑NA ❑ Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑Pass ❑Fail O NA ❑ Pass ❑Fail E NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail E NA ❑ Pass ❑Fail O NA ❑ Pass ❑ Fail ❑ NA ❑Pass ❑ Fail ❑NA Vent Piping Containment Tightness Test Result ❑Pass ❑Fail E NA ❑ Pass ❑ Fail E NA ❑Pass ❑Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑Pass ❑Fail E NA ❑Pass ❑ Fail E NA ❑Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑NA Vapor Recovery Piping Containment Tightness Test Result ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Communication Test Result ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA ❑Pass ❑Fail ❑NA ❑Pass ❑Fail ❑NA Turbine/Product Piping Sump Tightness Test Result ❑ Pass ❑ Fail O NA ❑ Pass ❑ Fail E NA ❑ Pass ❑Fail ❑NA ❑ Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result ❑Pass ❑ Fail E NA ❑Pass ❑Fail 0 NA ❑ Pass ❑Fail ❑NA ❑ Pass ❑ Fail ❑ NA VENT/TRANSITION SUMP ID: a b C d Tightness Test Result ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA UDC ID: 1 1&2 Gasoline 2 3&4 Diesel Fuel 3 4 Tightness Test Result ❑Pass ❑Fail E NA ❑Pass ❑Fail E NA ❑ Pass ❑Fail ❑NA ❑ Pass ❑Fail ❑ NA UDC ID: 5 6 7 8 Tightness Test Result ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail ❑ NA El Pass El Fail ❑NA El Pass El Fail ❑ NA UDC ID: 9 10 11 12 Tightness Test Result ❑Pass ❑Fail ❑ NA ❑Pass ❑ Fail ❑ NA ❑Pass ❑Fail ❑NA ❑Pass ❑ Fail ❑ NA All items marked"Fail"or"NA"must be explained in their respective"COMMENTS"section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CON TING THIS TESTING I hereby certify that the secondary containment was tested in accordance with CallifoMCiptle f Rulations Title 2 DiVision 3,Chapter 16, ection 2637 and all the information contained herein is accurate. g � UST Service Technician Signature -w7w. ._7 "Aw `elJ CX APR 19 2019 CERS=California Environmental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Council,NA=Not Applicable,UDC=Under- Dispenser Containment ENVIRONMENTAL. HEALTH DEPARTMENT