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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Farm <br /> TYPE OF ACTION Ll Installation Li Repair 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10186665 03/09/2021 <br /> Facility Name <br /> CHEVRON 307709 <br /> Facilitâ–ºv Address Citi ZIP Code <br /> 10858 TRINITY PKWY STO TON 95219 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin,TX 78759 <br /> Service Technician Performing Test <br /> Jesus Saldivar <br /> ContractorlTank Tester License Number <br /> 743160 <br /> ICC Number ICC Expiration Date <br /> 8361393 06/13/2021 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW:EVR Phase 1 11/23/2022 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> VACUUM TEST SPILL BUCKETS <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that each spill container was rested 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. l understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total#of Pages <br /> Allp 3-9-21 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = Internatianal Cotte <br /> Council <br /> Page 1 of 2 <br />