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Appendix Vill <br /> Underground Storage Tank \ <br /> Spill Container Testing Report Forrn <br /> TYPE OF ACTION ❑ Installation ❑ IRepair El 12 Month <br /> 1. FAC�ILITY INFORMATION <br /> CCERS D Test Date <br /> I 10182251 02-1=2-2024 <br /> Facility C Name ARCHRD AMPM <br /> '�� Facility o� P C:�ode <br /> gddress O ST Z2 <br /> F 4$55 S IHW 99 <br /> C <br /> 2. SERIJICE TECHNICIAN INFORMATION <br /> CCompany Performing the Test Phone <br /> ECO CHEK 888-5=00-CHEK <br /> Mailing Address PO BOX 1394 LAFAY'ETTE CA 94549 <br /> Service Technician Performing Test Felix Ram lr@Z <br /> Contractor/Tank Tester License Number 08-1 740 5-31 -26 :=j <br /> ICC Number ICC Expiration Date <br /> 8883072-LJT 11/10/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications 73/17/2024 <br /> n Date <br /> Franklin Fueling - EBW & Phil Tite #10098837082024 <br /> OPW#104634 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PEI 100 LAKE TEST <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> /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. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature � Date 02-12-2024 Total # of Pages <br /> 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br /> ' 4�ILy -5131 j7q <br /> bli <br /> 1 CvtIG tLcl —� <br />