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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION El Installation El Repair u 6 I`vlonth R! 35 Month <br /> 9. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181447 11/17/2025 <br /> Facility Name <br /> TESORO/SPEEDWAY#68154 <br /> Facility Address City ZIP Code <br /> 2500 W LODI LODI 95242 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin, TX 78759 <br /> SeNice Technician Performing Test <br /> Jarrod Cooke <br /> Contractor/Tank Tester License Number <br /> 743160 <br /> ICC Number ICC Expiration Date <br /> 8155550 02/26/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> ICC:CA UST Service Technician 02/26/2027 <br /> PEI:RP1200 06/05/2079 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> lake test stp sumps <br /> vac test annulars <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> l hereby certify that the secondary containment was rested in accordance with California <br /> Code of Regulations, title 23, division 3, chapter 16, section 2 63 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 Date Total # of Pages <br /> 11/17/2025 4 <br /> CERS = California Environmental Reporting System, ICG = International Cede Council, <br /> ID = Identification. NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 5 <br />