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Appendix Vlll <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ® 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID TO <br /> ertification Date <br /> 10181227 /31/2025 <br /> Facility Name <br /> MCM14 Corp - Arco AM PM <br /> Facility Address City County Zip Code <br /> 130 S. Wilson Way Stockton San Joaquin 95205 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Elite IV Contractors _ _ 209 461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr Stockton CA <br /> Contractor/Tank Tester License <br /> Number 1001331 <br /> Service Technician Performing Test <br /> Benjamin Malaspina <br /> ----------- ----------- <br /> ICC Number ICC Expiration Date <br /> 9519380 106104/2026_ <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer& Test Equipment Training Certifications Expiration Date <br /> OPW 182799 06/30/2025 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components) Tested <br /> Hydrostatic 87 Master , 87 Slave , 91 Spill Buckets <br /> 5. CERTIFICATION BY THE SERVICE TECHNICIAN CONDUCTING THE TEST <br /> /hereby certify that each spill container was tested in accordance with Cal/fom/a Code of <br /> Regulations, able 23, division 3, chapter 16, section 2637.1;that required supporting documentation <br /> Is attached;and all information contained herein/s accurate. /understand that test procedures shall <br /> be made avallab/e upon request by the goveming authority. <br /> Service Technician Signature Date Total # of Pages <br /> 01/31/2025 2 <br /> CERS= California Environmental Reporting Syste:rn, GPH= Gallons Per Hour, ID= Identification, ICC= <br /> International Code Council <br />