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Appendix VIII <br /> Spill <br /> 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 /> 10187387 9/22/22 <br /> Facility Name <br /> Cruisers BP29 <br /> Facility Address City ZIP Code <br /> 1137 W. Lathrop Manteca 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> L.C. Services 559-444-1730 <br /> Mailing Address <br /> 3887 N Valentine _ <br /> Service Technician Performing Test <br /> Mark Steinhauer <br /> Contractorf rank Tester License Number <br /> 779267 <br /> ICC Number ICC Expiration! Date <br /> 8357758 2125123 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS Phase I EVR #1002993709 6/19/2023 <br /> OPW Phase 1 EVR #0148614 11/9/2023 <br /> 4. TEST PROCEDURE INFORMATION. <br /> Test Procedures Used Components Tested <br /> Hydrostatic 87, 91, DSL <br /> 5. CERTIFICATION BY SERVKCAE TECHNICIAN CONDUCTING TEST <br /> 1 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 m de available upon request by the governing authority. <br /> Service Technician Signatur Datf Total # of Pages <br /> CERS = California Environmental R oO ing System, ID = identification, ICC = International Code <br /> Council <br />