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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑Installation ❑Repair x12 Month <br /> 1. FACILITY INFORI RATION <br /> CERS ID Test Date <br /> 10746623 02/17/2025 <br /> Facility Name <br /> Pershing Holdings, nc. <br /> Facility Address City ZIP Code <br /> 1329 Escalon Ave. Escalon � 95320 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Diamond Petroleum Services, Inc. (925)470-0803 <br /> Mailing Address <br /> 3619 King Ct Antio h, CA 94509 <br /> Service Technician F erforming Test <br /> Guadalupe Sanche <br /> Contractor/Tank Tes r License Number <br /> 1005444 <br /> ICC Number ICC Expiration Date <br /> 5250451 04/01/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and TE st Equipment Training Certifications Expiration Date <br /> OPW Phase 1 UST VR#0163765 06/06/2025 <br /> 4. TEST PROCED E INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatict Test 87 and 91 Fill Spill Buckets <br /> S. 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 i ormation contained herein is accurate.l understand that test procedures shall be <br /> made available up4 in request by the governing authority. <br /> Service Technician ignature Date Total #of Pages <br /> 02/17/2025 2 <br /> 6. SPILL CONTAIN ER DET S - <br /> Test Method Developed by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />