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UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM ( Page 1 of 6 ) Type of Action ❑ Installation Test ❑ Repair Test ❑ Six Month Test I] 36 Month Test I . FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10181513 1 8/27/2019 Business Name (Same as Facility Name or DBA-Doing Business As) VDP - Ripon CFN Business Site Address City ZIP Code 816 South Frontage Road Ripon 95366 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 111 . SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID : (By tank number, stored product, etc.) A T- 1 - Diesel B T-2 -87 C T-3 -91 D Tank Containment Tightness Test Result p Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA p Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Product Piping Containment Tightness Test Result p Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA El Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result p Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA p Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail EI NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail O NA ❑ Pass ❑ Fail ❑ NA Vent Piping Containment Tightness Test Result O Pass ❑ Fail ❑ NA p Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail ❑ NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ElFail O NA O Pass ElFail ElNA p Pass ❑ Fail ❑ NA 171Pass ElFail ElNA Communication Test Result ❑ Pass ❑ Fail p NA O Pass ❑ Fail ❑ NA p Pass ❑ Fail ❑ NA ❑Pass ❑ Fail ❑ NA Turbine / Product Piping Sump Tightness Test Result O Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA El Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA i Fill Riser Sump i Tightness Test Result 0 Pass ❑ Fail ❑ NA El Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA VENT / TRANSITION SUMP ID : a b C d C Tightness Test Result ❑ Pass ❑ Fail EI NA ❑ Pass ❑ Fail 0 NAI ❑ Pass ❑ Fail p NA ❑ Pass ❑ Fail ❑ NA UDC ID : 1 1 &2 2 3&4 3 5&6 4 Tightness Test Result O Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA EI Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 5 6 7 8 Tightness Test Result ❑ Pass Elail ❑ NA ElPass OF il ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 9 10 11 12 Tightness Test Result ❑ 'ass El 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 CONDUCTING THIS TESTING I hereby certify that the secondary containment was tested in accordance with Californi I t 3 , Division 3 , Chapter 16 , Section 2637 and all the information contained herein is accurate . UST Service Technician Signature SEP 16 2019 CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = Intemational Code Council, NA = Not Applicable, UDC = Under- Dispenser Containment ENVIRONMENTAL HEALTH PERMIT/ SERVICES