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Appendix VIII <br /> Underground Storage Tank 23205482 <br /> Spill Container Testing Report Foran <br /> TYPE OF ACTION ❑Installation ❑Repair ❑✓ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10339507 11/9/2023 <br /> Facility Name <br /> Arco 7049 <br /> Facility Address City ZIP Code <br /> 800 E. Kettleman Lane Lodi 95240 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Gettler-Ryan Inc. 925-551-7444 <br /> Mailing Address <br /> 6805 Sierra Court, Suite G, Dublin, CA 94568 <br /> Service Technician Performing Test <br /> Darnell Smith <br /> Contractor/Tank Tester License Number <br /> 220793 <br /> ICC Number ICC Expiration Date <br /> 8709494 11/17/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW UST EVR Phase 1 Tech Cert #0174705 7/6/2024 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> 1 Hour Hydrostatic All Spill Buckets <br /> 5. 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 2637.1; that required supporting <br /> documentation is attached; and all information contained herein is accurate. l understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total# of Pages <br /> -z 11/9/2023 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />