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Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br />Page 1 of 6 <br />TYPE OF ACTION □Installation □Repair □6 Month  36 Month <br />CERS ID <br />10181479 <br /> <br />Test Date <br />2022-09-20 <br />Facility Name <br />Mid City Ca FO Regen <br />Facility Address <br />13850 Devries Road <br />City <br />Lodi <br />ZIP Code <br />95242 <br />Company Performing the Test <br />SunWest Engineering Constructors, Inc <br />Phone <br />(888) 588-8737 <br />Mailing Address <br />4780 Cheyenne Way, Chino, CA 91710 <br />Service Technician Performing Test <br />Leonardo Aguilar, Jr. <br />Contractor/Tank Tester License Number <br />703190 <br />ICC Number <br />5302718 <br />ICC Expiration Date <br />12/2/2023 <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />FFS Sump Test System Operation INCON Level 4 10/22/2023 <br />Xerxes 4/1/2024 <br />Test Procedures Used Components Tested <br />Industry standard All secondary containment components <br />I hereby certify that the secondary containment was tested in accordance with California <br />Code of Regulations, title 23, division 3, chapter 16, section 2637; 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 <br />2022-09-20 <br />Total # of Pages <br />6 <br />1. FACILITY INFORMATION <br />2. SERVICE TECHNICIAN INFORMATION <br />3. TRAINING AND CERTIFICATIONS <br />4.TEST PROCEDURE INFORMATION <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />PEI RP 1200 All secondary piping