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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 2112 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 95215 <br /> II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Test (Print as shown on the /CC Certification) Phone # <br /> Elmer Mortera (408 ) 942 -8686 <br /> Contractor t Tank Tester License # ICC Certification # ICC Certification Expiration Date <br /> 396575 5248052- UT 41213=01 �Q191d <br /> Spill Container Testing Training and Certifications (List applicable certifications.) is <br /> Caldwell Sump Tester . <br /> J � <br /> III . SPILL CONTAINER TESTING INFORMATION <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify): <br /> ❑x Industry Code or Engineering Standard (Specify): <br /> RP1200 Eft Ile <br /> ❑ Engineered Method (Specify): <br /> Attach the testing procedures and alt documentation required to determine the results. # of Attached Pages <br /> TANK ID: (By tank number, stored product, etc.) T1 -Diesel T2-Diesel Res , T311wNew Oil T4-Waste Oil <br /> Spill Container Manufacturer: OPW OPW OPW OPW <br /> Method of Cathodic Protection: x❑ Non-Metallic 9 Non-Metallic 0 Non-Metallic Z Non-Metallic <br /> ❑ Isolation ❑ Isolation ❑ Isolation ❑ Isolation <br /> j ❑ Other (Specify in V.) ❑ Other (Specify in V.) ❑ Other (Specify in V.) ❑ Other (Specify in V.) <br /> Inside Diameter of Spill Container: (inches) 12 12 12 12 " <br /> Depth of Spill Container: (inches) 14 US' 15 13 " <br /> Does the spill container have a 5 gallon capacity? El Yes ❑ No ❑ Yes Z No Z Yes _❑ No ❑ Yes El No <br /> Method to Keep Spill Container Empty: ❑x Drain Valve 0 Drain Valve [E Drain Valve Q 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 : 21 Pass ❑ Fail El Pass ❑ Fall 0 Pass ❑ Fail Q Pass ❑ Fail <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 /> 1 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 maybe attached. <br /> i' CERS = Ca6forda EnvilroniTiental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = Intemallonal Code Council <br /> j UNA08 www.unidoes. org Ill Rev. 06/14/18 <br />