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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 Test Date <br /> 10181485 2/14/2024 <br /> Facility Name <br /> YRC#813 <br /> Facility Address City ZIP Code <br /> 1535 East Pescadero Ave, Tracy 95304 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> NWESTCO LLC. (800) 339-9930 <br /> Mailing Address <br /> 2209 Zeus Court, Bakersfield, CA 93308 <br /> Service Technician Performing Test <br /> Michael Stromecki <br /> Contractor/Tank Tester License Number <br /> 1073967 <br /> ICC Number ICC Expiration Date <br /> 8339168 2/26/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS VR-101 (Phil-Tite, EBW) 1006623708 11-29-2022 12/19/2024 <br /> OPW UST-EVR 0175532 7/31/2024 <br /> CNI Mfg VR-104#4117 3-22-2021 3/5/2025 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PEI RP1200 section 6 thru 6.2.6 Spill Containers <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. 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 /> 2/14/2024 4 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />