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Appendix Vill <br /> Underground Storage Tank <br /> Spill Container Testing Report Forl <br /> TYPE OF ACTION ® Installation ® Repair ❑ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10182157 03/06/2023 <br /> Facility Name <br /> 76 Express Tiger NO. 1 <br /> Facility Address City County Zip Code <br /> 5777 French Camp Stockton 95206 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Elite IV Contractors (209)461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr Stockton CA <br /> Contractor/Tank Tester License <br /> Number 1001331 <br /> Service Technician Performing Test <br /> Ben Malaspina <br /> ICC Number ICC Expiration Date <br /> 9519380 06/17/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer& Test Equipment Training Certifications Expiration Date <br /> OPW EVR UST 182799 05/19/2023 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components) Tested <br /> Hydrostatic (2) Diesel Spill Buckets <br /> 5. CERTIFICATION BY THE SERVICE TECHNICIAN CONDUCTING THE TEST <br /> I hereby certify fiat each spill container was Nested in accordance with Califhmia Code of <br /> Regulations, DO 23, division 3, chapter 16, section 2637.1,Mat required supporting documentation <br /> is attached,•and all information contained herein is accufate, I understand that lest procedures shall <br /> be made avar`lable upon request by the goveming a&MoMy. <br /> Service Tec ician Sign tpe Date Total #of Pages <br /> 03/06/2023 2 <br /> CERS=�California Environmental Reporting System, GPH= Gallons Per Hour, ICS= Identification, ICC- <br /> International Code Council <br />