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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTIOh ❑Installation ❑Repair x12 Month <br /> 1. FACILITY INFOF MATION <br /> CERS ID Test Date <br /> 10761034 04/04/2024 <br /> Facility Name <br /> ARCO am/pm # 83 31 <br /> Facility Address City ZIP Code <br /> 1904 Daniels St Manteca 95337 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performin the Test Phone <br /> Diamond Petroleum Services, Inc. (925)470-0803 <br /> Mailing Address <br /> 3619 King Ct Antioch, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> Contractor/Tank Te ter License Number <br /> 1005444 <br /> ICC Number ICC Expiration Date <br /> 5250451 04/01/2025 <br /> 3. TRAINING AND ERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW PHASE 1 EVR. UST# 0163755 06/06/2025 <br /> 4. TEST PROCEDL RE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatict Test 87,91 and Diesel Fill Spill Buckets <br /> 5. CERTIFICATIO BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify tha t each spill container was tested in accordance with California Code of <br /> Regulations, title 2 3, division 3, chapter 16, section 2637.1;that required supporting documentation is <br /> attached,and all ir formation contained herein is accurate.)understand that test procedures shall be <br /> made available upon request by the governing authority. <br /> Service Technician 13ignature Date Total #of Pages <br /> 04/04/2024 2 <br /> ---zr—e- _-:� =::::5& <br /> 6. SPILL CONTAIN'ER DETAILS <br /> Test Method Developed by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />