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Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair <br />® 12 Month <br />210302-332 <br />1. FACILITY INFORMATION <br />CERS ID <br />10181481 <br />Test Date <br />04/20/21 <br />Facility Name <br />Manteca CA FO REGEN <br />Facility Address <br />2551 E. Louise Ave. <br />City <br />Lathrop <br />ZIP Code <br />95330 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />SunWest Engineering Constructors, Inc. <br />e <br />E(858&8737 <br />Mailinq Address <br />4780 Cheyenne Way, Chino, CA 91710 <br />Service Technician Performing Test <br />Kraig Kinder <br />Contractor/Tank Tester License Number <br />CA -703190 <br />ICC Number <br />8296393 <br />ICC Expiration Date <br />11/18/21 <br />3. ! TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />OPW <br />6/26/21 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Industry Standard <br />OPW 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 <br />Kraig Kinder oaten M;�2012:08 6'"°8f <br />Date <br />04/20/21 <br />Total # of Pages <br />2 <br />CERS =California Environmental Reporting System, ID =Identification, ICC =International Code <br />Council <br />Page 1 of 2 <br />