Laserfiche WebLink
Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑Installation ❑Repair x12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181249 02/06/2025 <br /> Facility Name <br /> ARP Mini Mart Mobil <br /> Facility Address City ZIP Code <br /> 25775 S Patterson Pass Rd Tracy 95377 <br /> 2. SERVICE TECHNI IAN INFORMATION <br /> Company Performing he Test Phone <br /> Diamond Petroleum Services, Inc. (926)470-0803 <br /> Mailing Address <br /> 3619 King Ct Antiocl i, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> r10 <br /> tractor/Tank Test r License Number <br /> 5444 <br /> ICC Number ICC Expiration Date <br /> 6250451 04/01/2025 <br /> 3. TRAINING AND C ERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS EVR Phase I Systems -VR-101 # 1031393709 02/18/2026 <br /> 4. TEST PROCEDU IE INFORMATION <br /> Test Procedures Usc d Components Tested <br /> Hydrostatict Test 87,91 and Diesel Fills <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify tha each spill container was tested in accordance with California Code of <br /> Regulations, title 2 , division 3, chapter 16, section 2637.1;that required supporting documentation is <br /> attached,and all in Formation contained herein is accurate.l understand that test procedures shall be <br /> made available up n request by the governing authority. <br /> Service Technician bignature Date Total # of Pages <br /> 02/06/2025 2 <br /> 6. SPILL CONTAIIS ER DET S <br /> Test Method Developed by 4D Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = CaliforniaEnvironmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />