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Appendix 1/11 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION 11 Installation El Repair 116 Month 0 36 Month <br /> 1.' FACILITY INFORMATION <br /> CERS ID Test Date <br /> 1039987 12/29/21 <br /> Facility Name <br /> Hunt & 8ons Inc. <br /> Facility Address City ZIP Code <br /> 4733 S. Hwy 99 Frontage Rd Stockton <br /> 195352 <br /> 2, SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Donlee Pump Company 209 537-9396 <br /> Mailing Address <br /> 2825 Railroad Ave. Ceres CA. 95307 <br /> Service Technician Performing Test <br /> Gerardo Perez <br /> ContractorlTank Tester License Number <br /> 432039 <br /> ICC Number ICC Expiration Date <br /> 8962656 3/14/2023 <br /> 3.`.TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling 9121122 <br /> OPW 8126122 <br /> EMC® 5131121 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Sump Tester Incon Level 4 <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING.TEST <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 Total # of Pages <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 5 <br />