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UNDERGROUND STORAGE TANK SPILL CONTAINER TESTING REPORT FORM Type of Action ❑ Installation Test ❑ Repair Test X 12 Month Test I . FACILITY INFORMATION CERS ID Date of Spill Container Test 10181885 01 /04/2019 Business Name (Same as Facility Name or DBA-Doing Business As.) VALLEY PACIFIC LODI PLANT & CARDLOCK Business Site Address City ZIP Code 931 E Victor Ave . Lodi 95240 11 , UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Phone # Garrett Warren 1 ( 916 ) 991 - 1100 Contractor/Tank Tester License # ICC Certification it ICC Certification Expiration Date CSLB#803616 SWRB#06 - 1672 8185019 10-2-2019 41 Nam Spill Container Testing Training and Certifications (List applicable certifications) I OPW EVR 101018 exp . & 9 -2019 1 p III , SPILL CONTAINER TESTING INFORMATION FEBX19 Test Method Used : E] Manufacturer Guidelines: (Specify) X Industry Code or Engineering Standard : RP 1200 , { T { yk n `a RAF 4 (Specify) ❑ Engineered Method : (Specify) # of Attached Pages Attach the testing procedures and all documentation required to determine the results. Tank ID : (By tank number, stored product, etc.) T6 : 87 UNL T7 : 87 UNL Spill Container Manufacturer: OPW OPW 9 Non -Metallic M Non -Metallic ❑ Non-Metallic ❑ Non-Metallic Method of Cathodic Protection 0 Isolation IN Isolation ❑ Isolation ❑ Isolation ❑ Other ❑ Other ❑ Other ❑ Other (Specify in section V.) (Specify in section V,) (Specify in section V) (Specify in section V.) Inside Diameter of Spill Container: (Inches) Depth of Spill Container: (Inches) Does the spill container have a 5 gallonEI Yes ❑ No a Yes ❑ NorEE11es ❑ No ❑ Yes El capacity? IN Drain Valve IN Drain Valve ❑ Drain Valve ❑ Drain Valve Method to Keep Spill Container Empty ❑ Onsite Pump ElOnsite Pump ElOnsite Pump ❑ Onsite Pump ❑ Other ❑ Other ❑ Other ❑ Other (Specify in section V.) (Specify in section V.) (Specify in section V.) (Specify in section V.) IV. SUMMARY OF TESTING RESULTS Spill Container Test Results X Pass ❑ Fail ❑ Pass ❑ Fail V. COMMENTS All items marked "Fail" above must be explained in this section. Any additional comments may also be provided here. The T7: UNL bucket failed . It originally spun in the ground during the OPI inspection . Bucket will be replaced and tested at a later date. VI . CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the spill containers were tested in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637. 1 and all the information contained herein is accurate. UST Service Technician Signature If the facility has more components than thts forff accommodates, additional copies of this page may be attached. CERS = California Environmental Reporting System, ID = Identification, UST = Underground storage tank, ICC = International Code Council