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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION Ll Installation -L-2, Repair �6 12 Month <br /> 1. FACILITY INFORMATION <br /> GERS ID Test Cate <br /> 10185183 07/08/2025 <br /> Facility name <br /> Aisle-1 #2356 <br /> Facility Address City ZIP Code <br /> 4219 East Morada Lane Stockton 95212 <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 /> Service Technician Performing Test <br /> Jesus Saldivar <br /> Contractor/Tank Tester License Dumber <br /> 743160 <br /> ICG Number IGG Expiration Date <br /> 8361393 05/12/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling:Phil-Tite EVR Ph 1 Systems 07/10/2026 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Vacuum test Spill buckets <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 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. 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 /> I,rt 07/08/2025 2 <br /> GERS = California Environmental Reporting System, IC = Identification, ICG = International Cade <br /> Council <br /> Page 1 of 2 <br />