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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM tiPage 1 of 6) Type of Action ❑ Installation Test ❑Repair Test ❑Six Month Test ®36 Month Test I. FACILITY INFORMATION CERS ID 10181411 Date of Secondary Containment Test 4/2/2019 Business Name(Same as Facility Name or DBA-Doing Business As) Shell 136186 Business Site Address City ZIP Code 3725 N.Tracy Blvd. Tracy 95376 11. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test(Print as shown on the ICC Certification) Phone# Michael McCarter (707)545-5522 Contractor/Tank Tester License# ICC Certification# ICC Certification Expiration Date Able Maintenance, Inc.-312844 8819839 10/25/2019 III. SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID:(By tank number,stored product,etc.) A 87 B 89 C 91 D Diesel Tank Containment Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Product Piping Containment Tightness Test Result ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA Communication Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Remote Fill Piping Containment Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Communication Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Vent Piping Containment Tightness Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Communication Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Vapor Recovery Piping Containment Tightness Test Result [:]Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Communication Test Result ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail 0 NA Turbine/Product Piping Sump Tightness Test Result ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA Fill Riser Sump Tightness Test Result ❑Pass 0 Fail ❑NA 0 Pass ❑Fail ❑NA ❑Pass 0 Fail ❑NA 0 Pass ❑Fall ❑NA VENT/TRANSITION SUMP ID: -la b C d Tightness Test Result ❑Pass [-]Fail 0 NA ❑Pass ❑Fail 0 NA ❑Pass ❑Fail ID NA ❑Pass ❑Fail 0 NA UDC ID: 1 1/2 23/4 35/6 4718 Tightness Test Result ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA ❑Pass 0 Fail ❑NA UDC ID: 59110 611/12 713/14 815/16 Tightness Test Result 0 Pass ❑Fail ❑NA El Pass 0 Fail ❑NA 0 Pass ❑Fail ❑NA ❑Pass 0 Fail ❑NA j UDC ID: 9 11 10 11 12 Tightness Test Result ❑Pass ❑Fail ❑NA ❑Pass ❑Fail p NA ❑Pass ❑Fail ❑NA I ❑Pass ❑Fail ❑NA i All items marked"Fail"or"NA"must be explained in their respective"COMMENTS"section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTI Hi.S TEStiNG I hereby certify that the secondary containment was tested in accordance with California Collie d RLegulations,Title 23,Division 3,Chapter 16,Section 2637 and all the information contained herein is accurate. UST Service Technician Signature CERS=California Environmental Reporting System,ID=identification,UST=Undergr[xrid Storage Tank,ICG=Internationalf UDC=Under- Dispenser Containment I �l ii J , \I; ,-4 E;='1 LT H DEPARTMENT