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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair M 12 Month <br /> 1 . FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10184915 3/ 15/2022 <br /> Facility Name <br /> Kesar Petroleum Inc . <br /> Facility Address City ZIP Code <br /> 717 W Eighth St . Stockton 95206 <br /> 2 SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Pinnacle Fuel Compliance 408 - 206 -9840 <br /> Mailing Address <br /> P . O . Box 32849 <br /> Service Technician Performing Test <br /> Jeff Conger <br /> Contractor/Tank Tester License Number <br /> 90 = 1116 <br /> ICC Number ICC Expiration Date <br /> 1081782 12 /05/2022 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS EVR Phase I — VR101 ( Phil -tite) # 1020003708 3/9/2023 <br /> OPW #104789 3/9/2023 <br /> 4 . TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PEI 1200 Spill bucket integrity <br /> FFS EVR Phase I Spill bucket integrity <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. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 3/ 15/2022 2 <br /> CERS = California Environmental Reporting System , ID = Identification , ICC = International Code <br /> Council <br /> Page 1 of 2 <br />