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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair R 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10151123 10/9/2020 <br /> Facility Name <br /> Sprint Stockton <br /> Facility Address City ZIP Code <br /> 3807 Coronado Ave. Stockton 95204 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> J a u re g u i & Culver Inc. 760-743-0518 <br /> Mailing Address 959 W. Mission Ave. Escondido 92025 <br /> Service Technician Performing Test Benjamin JaUregUl <br /> Contractor/Tank Tester License Number 708231 <br /> ICC Number 8277373 ICC Expiration Date <br /> 9/12/2021 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW 103928 2/9/2022 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PEI 1200 Spill Bucket <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that each spill container was tested in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.1; 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 Signature Date 10/9/2020 Total # of Pages <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />