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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION El installation <br /> CD Repair ❑ 6 Month ❑ 36 Month <br /> r <br /> 1. FACILITY INFORMATION Test Date <br /> 0312112023 <br /> CERS ID <br /> 10134451 <br /> Is Facility Name <br /> Unocal 76 City ZIP Code <br /> Facility Address Stockton 95219 <br /> 2701 west March Lane <br /> 2. SERVICE TECHNICIAN INFORMATION Phone <br /> (707)545-5522 <br /> Company Performing the Test <br /> Able Maintenance,Inc. <br /> Mailing Address <br /> 3224 Regional Parkway,Santa Rosa CA 95403 <br /> Service Technician Performing Test <br /> Eusebio Sousa h <br /> Contractor/Tank Tester License Number <br /> Able Maintenance,Inc./312844 ICC Expiration Date <br /> ICC Number 0612512023 <br /> 5254516 <br /> 3. TRAINING AND CERTIFICATIONS Expiration Date <br /> Manufacturer and Test Equipment Training Certifications 0312012024 <br /> INCON TS-STS L4-1012573708 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic UDC's <br /> Pressure Secondary piping <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> /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 /> 0312112023 4 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, Page 1 o' <br />