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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM (Page 1 of 6) Typedon ❑ Installation Test ❑ Repair Test 0 Six Month Test ❑ 36 Month Test I . FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10180733 02-09-19 Business Name (Same as Facility Name or DBA-Doing Business As ) ARCO ;'#7147 Business Site Address City ZIP Code 1206 E. MARCH LANE STOCKTON 95210 11. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Phone # DAVID ROUSE ( 916 ) - 826 Ext. 6176 Contractor/Tank Tester License # ICC Certification # ICC Certification Expiration Date 220793 8292530 06-28-20 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS Tank ID : (Sy lank number, stoned product, etc.) A T1 : B T2 : C T3: DIESEL D UNLEADED PREMIUM Tank Containment Tightness Test Result ® Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA 0 Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA Product Piping Containment Tightness Test Result ❑ Pass 0 Fall ❑ NA 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail 0 NA ❑ Pass 0 Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass 0 Fail 0 NA ❑ Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fait ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail [] NA Vent Piping Containment Tightness Test Result 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail 0 NA 0 Pass 0 Fail 0 NA 0 Pass ❑ Fail [INA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass 0 Fail ❑ NA ❑ Pass 0 Fail Cl NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA 0 Pass ❑ Fail ❑ NA Turbine i Product Piping Sump Tightness Test Result ❑ Pass ❑ Fall ❑ NA ❑ Pass ❑ Fail 0 NA 0 Pass 0 Fail ❑ NA 0 Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass 0 Fail ❑ NA Vent I Transition Sump ID: a b c d Tightness Test Result ❑ Pass ❑ Fail 0 NA ❑ Pass 0 Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID: 1 3 Tightness Test Result 0 Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail 0 NA UDC We $ $ 7g Tightness Test Result ❑ Pass ❑ Fail El NA ❑ Pass [03 Fail El NA ❑ Pass ❑ Fail ❑ NA 0 Pass ❑ Fail 0 NA UDC ID : 9 10 11 12 Tightness Test Result ❑ Pass ❑ Fail 0 NA 0 Pass ❑ Fail]❑ NA ❑ Pass ❑ Fail 0 NA ❑ Pass ❑ Fail ❑ NA Aft items marked "Fail" or VIA " must be explained in their respective "COMMENTS" section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the secondary containment was tested in accordance with California Code of Regulations, title 23 , division 3 , chapter 16, section 2637 and all the information cwitalned herein Is accurate. UST Service Technician Signature CERS = California Environmental Reporting System, ID = Identification, UST = Underground storage tank, ICG = International Code Council, NA = Not applicable, UDC = UnderAlspenser containment