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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION LJ Installation Ll Repair R3 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181447 06/16/2025 <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 Perforating the Test Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin, TX 78759 <br /> Service Technician Performing Test <br /> Carlos Zaragoza <br /> Contfactor/Tank Tester License Number <br /> 743160 <br /> ICC Number ICG Expiration Date <br /> 10400957 07/29/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> ICC:CA UST Service Technician 07/29/2026 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> INDUSTRY STANDARD SB <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that each spill container was rested 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. 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 /> 06/16/2025 2 <br /> CERS = California Environmental Reporting System, ID = Identification; [CC = International Code <br /> Council <br /> Page 1 of 2 <br />