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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑x Repair ❑ 6 Month Ir 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10182305 1/15/2025 <br /> Facility Name <br /> 7-Eleven #41341 <br /> Facility Address City ZIP Code <br /> 4405 Pacific Ave. Stockton 95207 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Walton Engineering, Inc. (916) 373-1166 <br /> Mailing Address <br /> P.O. Box 1025, West Sacramento, CA 95691 <br /> Service Technician Performing Test <br /> David Delgado <br /> Contractor/Tank Tester License Number <br /> 617238 <br /> ICC Number ICC Expiration Date <br /> 5246959 10/20/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Incon Level 4 12/22/2025 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic 91 STP Sump <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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> Z�)a't 4d 1/15/2025 5 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> UN-054 www.unidocs.org Rev.10/01/20 Page 1 of 5 <br />