Laserfiche WebLink
Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION © Installation © Repair © 12 Month <br /> 1 . FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181387 2/17/2022 <br /> Facility Name <br /> Ryder Truck Rental <br /> Facility Address City ZIP Code <br /> 3633 Duck Creek Rd . Stockton 95125 <br /> 2 . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Balch Petroleum (408 ) 942 -8686 <br /> Mailing Address <br /> 930 Ames Ave . Milpitas , CA 95035 <br /> Service Technician Performing Test <br /> Rolando Urbina <br /> Contractor/Tank Tester License Number <br /> 396575 <br /> ICC Number ICC Expiration Date <br /> 8009631 - UT 8/19/2023 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS EVR Phase 1 Systems - VR101 # 1004483713 12/3/2023 <br /> 4 . TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> RP1200 Spill Buckets <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 Total # of Pages <br /> 2/ 17/2022 2 <br /> CERS = California Environmental Reporting System , ID = Identification , ICC = International Code <br /> Council <br /> uNA08 www. unidoes. org Rev. 10/01 /20 Page 1 of 2 <br />