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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 X 12 Month Test <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Spill Container Test <br /> 10181317 5/28/2020 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> ESTES FREIGHT <br /> Business Site Address City ZIP Code <br /> 7611 AIRPORT BLVD STOCKTON 95206 <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 /> FELIX RAMIREZ ( 209 ) 744 -0112 <br /> Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date <br /> 08- 1740 5 - 31 -20 8883072 - UT 11 /9/2020 <br /> Spill Container Testing Training and Certifications (List applicable certifications.) <br /> Franklin Fueling - EBW & Phil Tite # 1009883708 11 /29/20 <br /> OPW # 104634 3- 14-20 <br /> III . SPILL CONTAINER TESTING INFORMATION <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify) : <br /> ❑x Industry Code or Engineering Standard (Specify) : LAKE TEST / PEI 100 <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.) DIESEL <br /> i <br /> Spill Container Manufacturer: OPW <br /> Method of Cathodic Protection : ❑x Non-Metallic ❑ Non-Metallic ❑ Non-Metallic ❑ Non-Metallic <br /> ❑ Isolation ❑ Isolation ❑ Isolation ❑ Isolation <br /> ❑ Other (specify in V.) ❑ Other (specify in V) ❑ Other (Specifyin V.) ❑ Other (Specify in V.) <br /> Inside Diameter of Spill Container: (Inches) 11 <br /> Depth of Spill Container: (Inches) 15 <br /> Does the spill container have a 5 gallon capacity? ❑x Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No El Yes El No <br /> Method to Keep Spill Container Empty: 9Drain Valve ❑ Drain Valve ❑ Drain Valve El Drain Valve <br /> ❑ Onsite Pump El Onsite Pump El Onsite Pump El Onsite Pump <br /> li L] Other (Specify in V) E] Other (Specify in V.) ❑ Other (Specify in V) ❑ Other (Specify in V) <br /> IV. SUMMARY OF TESTING RESULTS <br /> Spill Container Test Results : ❑x Pass ❑ Fail ❑ Pass ❑ Fail ❑ Pass ❑ Fail ❑ 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 /> JUN 0 8 2020 <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 is l <br /> If the facility has more components than this form accommodates, additional copies of this page may be attached. <br /> CERS = CaliFomia Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br />