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Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair 0 12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />Test Date <br />10181485 <br />2-24-23 <br />Facility Name <br />YRC Frieght #813 (Tracy) <br />Facility Address <br />City <br />ZIP Code <br />1535 East Pescadero Avenue <br />Tracy <br />95304 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Phone <br />Nwestco LLC <br />(800) 339-9930 <br />Mailing Address <br />2209 Zeus Court, Bakersfield, CA 93308 <br />Service Technician Performing Test <br />Rockland Kirk <br />Contractor/Tank Tester License Number <br />1073967 <br />ICC Number <br />ICC Expiration Date <br />10241356 <br />9-29-24 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />FFS 1026694137 10-16-24 <br />OPW 1193547 12-15-25 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />PEI 1200 <br />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. 1 understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature <br />Date <br />2-24-23 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Page 1 of 2 <br />