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Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION Ll Installation LJ Repair R1 12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10181455 <br />Facility Name <br />Stockton <br />Facility Address <br />1990 Piccoli Road <br />city <br />Stockton <br />Test Date <br />11/10/2022 <br />ZIP Code <br />95215 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Tanknology, Inc. <br />Phone <br />800-964-1250 <br />Mailing Address <br />11000 N Mopac Expy #500 Austin, TX 78759 <br />Service Technician Performing Test <br />Jesus Saldivar <br />Contractor/Tank Tester License Number <br />743160 <br />ICC Number <br />8361393 <br />ICC Expiration Date <br />06/11/2023 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />OPW.EVR Phase 1 <br />11/23/2022 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used Components Tested <br />H2O TEST SPILL BUCKETS <br />§. 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 2637.7; that required supporring <br />documentation is attached; and all information conrained herein is accurate. l understand <br />rhar resr procedures shall be made available upon request by the governing aurhoriry. <br />Service Technician Signature Date Total # of Pages <br />p„ 11/10/2022 2 <br />CERS = California Environmental Reporting System, ID = Identification; ICC = International Code <br />Council <br />Page 1 of 2 <br />