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Appendix VIl <br /> Underground Storage Tank <br /> econdary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 36 Month <br /> 1. FACILITY INFO MATION <br /> CERS ID Test Date <br /> 10181249 3/25/2026 <br /> Facility Name <br /> ARP MINI MART M BIL <br /> Facility Address City ZIP Code <br /> 25775 S Patterson Pass Rd Tracy 95376 <br /> 2. SERVICE TEC ICIAN INFORMATION <br /> Company Performi g the Test Phone <br /> Diamond Petroleu Services Inc. 925 470-0803 <br /> Mailing Address <br /> 3619 Kina Ct Antioch, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> ContractorlTank T ster License Number <br /> 1005444 <br /> ICC Number ICC Expiration Date <br /> 5260451 03/2212027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and est Equipment Training Certifications Expiration Date <br /> Caldwell System Level Change Indicator 06/2512025 <br /> Veeder Root Se ce ATG Service Tech 09/2512026 <br /> ZCLIXERXES US Installation 0211812027 <br /> Fiber Glass Syst ms I NOV 02/282028 <br /> 4. TEST PROCE I IURE INFORMATION <br /> Test Procedures sed Components Tested <br /> Pressure Test Secondary Lines <br /> Vacuum Test Annular Tanks <br /> Hydrostatic Test UDCs and Sumps <br /> 5. CERTIFICATI N BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify t at the secondary containment was tested in accordance with California <br /> Code of Regulat ons, title 23, division 3, chapter 16, section 2637; that required supporting <br /> documentation i attached; and all information contained herein is accurate. 1 understand <br /> that test proced res shall be made available upon request by the governing authority. <br /> Service Technicie n Signature Date Total #of Pages <br /> 03/2512025 5 <br /> CERS = Californi Environme tai Reporting System, ICC = international Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 5 <br />