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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION 11 Installation Cf Repair Q 12 Month <br /> ... . <br /> 1. FACILITY INFORMATION <br /> CE RS ID Test Date <br /> 10182331 01/15/2025 <br /> Facility Name <br /> CHEVRON 208118 N-4087-1-3 <br /> Facility Address ' City ZIP Code <br /> 3355 E. HAMMER LANE @ HOLMAN RD 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 Number <br /> 743160 <br /> ICG Number IGG Expiration Date <br /> 8361393 05/16/2025 <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 /> I hereby certify that each spill container was tested in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.1; 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 Dake Total ## of Pages <br /> /-1 01/15/2025 2 <br /> CERS = California Environmental Reporting System, ID = ldent'ficafion. ICG = International Code <br /> Council <br /> Page 1 of 2 <br />