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Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month 0 36 Month <br />1 1. FACILITY INFORMATION <br />CERS ID Test Date <br />10/12/2020 <br />Facility Name <br />California Stop <br />Facility Address <br />2224 S Manthey Rd <br />City <br />Stockton, CA <br />ZIP Code <br />95206 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Epic Environmental Compliance Systems, Inc <br />Phone <br />650-580-3317 <br />Mailing Address <br />39120 Argonaut Way # 643, Fremont, CA 94538 <br />Service Technician Performing Test <br />Brian Dunahay <br />Contractor/Tank Tester License Number <br />956593 <br />ICC Number <br />8021436 -UT <br />ICC Expiration Date <br />2/18/2021 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />B42886 <br />3/8/2021 <br />Caldwell Level Indicator <br />5/1/2021 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that the secondary containment was tested in accordance with California <br />Code of Regulations, title 23, division 3, chapter 16, section 2637, that required supporting <br />documentation is attached, and all information contained herein is accurate. I understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician SignaturerJ <br />Brian Dunahay <br />Date <br />10/12/2020 <br />Total # of Pages <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, <br />Page 1 of 5 <br />