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UNDERGROUND STORAGE TANK ;as SECONDARY CONTAINMENT TESTING REPORT FORM (Page i of 6) Type of Action installation Test ❑ Repair Test ❑ Six Month TestMpiM �� I . FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10180733 1 /3/2019 Business Name (Same as Facility Name or DBA-Doing Business As) Arca 7147 Business Site Address City ZIP Code 1206 E . March Lane Stockton 95210 Il. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the /CC Certifica(ion) Phone # David Rouse (916 ) 826-6176 Contractor i Tank Tester License # ICC Certification # ICC Certification Expiration Date 220793 8292530 6/28/2019 III . SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID : (By tank number, stored product, etc.) A T1 : Unleaded B T2 : Premium C T3 : Diesel D Tank Containment Tightness Test Result O Pass ❑ Fail EI NA ❑ Pass ❑ Fail E NA D Pass O Fail I@ NA ❑ Pass ❑ Fail El NA Product Piping Containment Tightness Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fall E NA E Pass Q Fail ❑ NA O Pass ❑ Fail E NA Communication Test Result O Pass ❑ Fail Ei NA Q Pass ❑ Fall p NA ❑ Pass ❑ Fail E NA Q Pass ❑ Fail E NA Remote Fill Piping Containment Tightness Test Result O Pass O Fail EI NA p Pass ❑ Fail E NA ❑ Pass ❑ Fail 17 NA ❑ Pass ❑ Fail E NA Communication Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail Ip NA ❑ Pass Q Fail E NA ❑ Pass ❑ Fail M NA Vent Piping Containment Tightness Test Result Q Pass ❑ Fail O NA ❑ Pass ❑ Fail ENA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA Communication Test Result ❑ Pass ❑ Fail I@ NA ❑ Pass ❑ Fall p NA ❑ Pass ❑ Fail M NA ❑ Pass ❑ Fail E NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail I@ NA ❑ Pass ❑ Fail E NA ❑ Pass [] Fail E NA Communication Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass Q Fail E NA ❑ Pass ❑ Fail O NA Turbine l Product Piping Sump Tightness Test Result ❑ Pass ❑ Fall E NA ❑ Pass ❑ Fail E NA O Pass ❑ Fall ❑ NA ❑ Pass ❑ Fail E NA Fill Riser Sump Tightness Test Result ❑ Pass O Fail E NA [] Pass ❑ Fail O NA Q Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA VENT l TRANSITION SUMP ID : a b C d Tightness Test Result ❑ Pass ❑ Fail M NA ❑ Pass Q Fail O NA ❑ Pass ❑ Fail O NA ❑ Pass ❑ Fail E NA E UDC ID : 1 2 3 4 E Tightness Test Result O Pass ❑ Fail R NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail W NA Mato UDC ID : $ 6 7 8 Tightness Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA UDC ID : 9 10 11 12 Tightness Test Result ❑ Pass ❑ Fail E NA O Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA All Items marked "Fall' or "NA " 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 Inform tion Wfitained herein is accurate. UST Service Technician Signature CERS = Gafifomia Environmental E System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council, NA = Not Applicable, UDC = Under- D4enser Contarnrrrent I