Laserfiche WebLink
Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION Ll Installation Repair �6 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10898140 05/28/2025 <br /> Facility Dame <br /> 7-ELEVEN 41342 <br /> Facility Address city ZIP Code <br /> 1233 E Dr. Martin Luther King Jr Blvd Stockton 95205 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin,TX 78759 <br /> Service Technician Performing Test <br /> Jesus Saldivar <br /> Contractor/Tank Tester License Number <br /> 743160 <br /> ICC Number IGC Expiration Date <br /> 8361393 05/12/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW:EVR Phase 1 01/07/2027 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Leak test spill buckets <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that each spill container was rested 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. l understand <br /> that rest procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total# of Pages <br /> ,,w,1w— 05/28/2025 2 <br /> CERS = California Environmental Reporting System, ID = Identification; ICG = International Code <br /> Council <br /> Page 1 of 2 <br />