Laserfiche WebLink
Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION Ll Installation LJ Repair 0 12 Month <br />1. FACILITY INFORMATION <br />CE RS ID Test Date <br />10181455 11/15/2023 <br />Facility Name <br />Stockton <br />Facility Address I City <br />1990 Piccoli Road Stockton <br />ZIP Code <br />95215 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test Phone <br />Tanknology, Inc. 1.800-964-1250 <br />Mailing Address <br />11000 N Mopac Expy #500 Austin, TX 78759 <br />Service Technician Performing Test <br />Jesus Saldivar <br />Contractor/Tank Tester License Number <br />743160 <br />ICG Number ICC Expiration Date <br />8361393 05/16/2025 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />OPW:EVR Phase 1 <br />01/04/2025 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />H2O TEST <br />Components Tested <br />SPILL BUCKET <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 2637.7, that required supporting <br />documentation is attached; and all information contained herein is accurate. l understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature <br />'A <br />Date <br />11/15/2023 <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 />