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Appendix VII PGE095 <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ❑✓ 36 Month <br />1. FACILITY INFORMATION <br />CERS ID Test Date <br />10148345 11/22/2022 <br />Facility Name <br />Pacific Gas and Electric Company <br />Facility Address City ZIP Code <br />4040 West Ln. Stockton 95204 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />TAIT Environmental Services, Inc. <br />Phone <br />�(714) 560-8222 <br />Mailing Address <br />11280 Trade Center Dr., Rancho Cordova, CA 95742 <br />Service Technician Performing Test <br />John Cascio <br />Contractor/Tank Tester License Number <br />588098 <br />ICC Number <br />5252163 <br />ICC Expiration Date <br />�8/211/2023 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Franklin Fueling Incon 4, 1000093709 <br />12-21-2022 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />PEI RP -1200 <br />Diesel Annular, Unleaded Annular, Waste Oil Annular, Diesel Sump, Unleaded Sump <br />Waste Oil Sump, Diesel Supply Secondary, Unleaded Supply Secondary, Waste Oil <br />Supply Secondary, Diesel UDC, Unleaded UDC1, Unleaded UDC2, Vent Sump, <br />Vent Secondary <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 <br />��64� <br />Date <br />11/22/2022 <br />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 />