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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 36 Month <br /> 1. FACILITY INFORMATION <br /> ' CERS ID �+ Test Date <br /> 1039987 113122 <br /> Facility Name --_ - - <br /> —7 <br /> Hunt & Sons Inc. <br /> Facility Address City ZIP Code <br /> 4733 S. Hwy 99 Frontage Rd Stockton _1963-52 <br /> 12. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Donlee PunwComDanv _ (2091537- <br /> , <br /> Mailing Address <br /> 2825 Railroad Ave. Ceres, CA. 95307 <br /> Service Technician Performing Test <br /> Gerardo Perez <br /> Contractor/Tank Tester License Number <br /> 432039 <br /> ICC Number ICC Expiration Date <br /> 8962656 3/14/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - Incon Level 4 9121122 <br /> OPW 8126122 <br /> Cn <br /> I <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Incon Level 4 Sumps, Piping, Annular Space <br /> PEI-1200 Sumps, Piping, Annular Space <br /> 1 y <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the secondary containment was tested in accordance with California <br /> Code of Regulations, title 23, division 3, chapter 16, section 2637; 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 Date Total # of Pages <br /> 04 t l 3 /ZZ_ <br /> CERS = California Environmental Reporting System, ICC = International Code Council-, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 5 <br />