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UNDERGROUND STORAGE TANK <br /> SPILL CONTAINER TESTING REPORT FORM(Page 1 of 1) <br /> Type of Action ❑Installation Test ❑Repair Test 0 12 Month Test <br /> __ I. FACILITY INFORMATION <br /> CERS ID Date of Spill Container Test <br /> 10181387 1/15/2019 <br /> Business Name(Same as Facility Name or DBA-Doing Business As) <br /> Ryder Truck Rental <br /> Business Site Address City ZIP Code <br /> 3633 Duck Creek Drive Stockton 195215 <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Test(Print as shown on the iCC Certification) Phone# <br /> Elmer Mortera (408) 942-8686 <br /> Contractor I Tank Tester License# ICC Certification# ICC Cert cation Expiration Date <br /> 396575 5248052-UT 12/30/2019 <br /> Spill Container Testing Training and Certifications(List applicable certifications) <br /> Caldwell Sump Tester <br /> III. SPILL CONTAINER TESTING INFORMATION <br /> __ <br /> Test Method Used: ❑Manufacturer Guidelines(Specify): <br /> ❑x Industry Code or Engineering Standard(Specify): RP1200 <br /> ❑Engineered Method(Specify): <br /> Attach the testing procedures and all documentation required to determine the results. #of Attached Pages <br /> TANK ID:(By tank number,stored product,etc.) T1-Diesel T2-Diesel Res. T3-New Oil T4-Waste Oil <br /> Spill Container Manufacturer: OPW OPW OPW OPW <br /> Method of Cathodic Protection: 0 Non-Metallic ❑x Non-Metallic ❑x Non-Metallic ❑x Non-Metallic <br /> ❑ Isolation ❑Isolation ❑Isolation ❑Isolation <br /> ❑Other(Specify in V.) ❑Other(Specify in V.) ❑Other(Specify in V) ❑Other(Specify in V.) <br /> Inside Diameter of Spill Container:(inches) 1211 12" 12" 1291 <br /> Depth of Spill Container:(inches) 14" 14.5" 15" 13" <br /> Does the spill container have a 5 gallon capacity? Fil Yes ❑No ❑Yes I]No Q Yes ❑No ❑Yes 0 No <br /> Method to Keep Spill Container Empty: 0 Drain Valve ❑x Drain Valve ❑x Drain Valve ❑x Drain Valve <br /> ❑Onsite Pump ❑Onsite Pump ❑Onsite Pump ❑Onsite Pump <br /> ❑Other(Specify in v.) ❑Other(Specify in V.) ❑Other(Specify in V.) ❑Other(Specify in V.) <br /> IV. SUMMARY OF TESTING RESULTS <br /> Spill Container Test Results: 91 Pass ❑Fail N Pass ❑Fail ❑x Pass ❑Fail ❑x Pass ❑Fail <br /> .. ..... .. . <br /> V. COMMENTS <br /> Any items marked"Fail"above must be explained in this section. Any additional comments may also be provided here. <br /> VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> I hereby certify that the spill containers were tested in accordance with California Code of Regulations, Title 23, Division 3, <br /> Chapter 16,Section 2637.1 and all the information contained herein Is accurate. <br /> UST Service Technician Signature <br /> If the facility has more components than this form accommodates,additional copies of this page may be attached. <br /> CERS=California Environmental Reporting System,ID=Identification,UST=Underground Storage Tank,ICC=International Code Council <br /> UN-108 www.unidocs.org 1/1-Rev.06/14/18 <br />