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Appendix VIII <br /> LI nderground Storage Tank <br /> Spill ContainerTestin Report Form <br /> TYPE OF ACTION ❑ Installation :1 Repair [9 12 Month <br /> 1.FACILITY INFORMATION <br /> EIS ID - Test Date <br /> 10182151 10123125 <br /> Facility Name <br /> Ramos Oil Company <br /> Facility Address city ZIP Code <br /> 10842 S Harland Raod French Camp 95231 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> JIB Petroleum Service 91 -37'2-5 93 <br /> Mailing Address <br /> 3065 Asante Lane, West Sacramento Ca 95691_ _ <br /> Service Technician Performing Test <br /> Gabe Garcia <br /> ontracto rfTa nk Tester License Number <br /> ICC NUMt>er ICD Expiration Date <br /> 5252406 1012026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW 61202fi <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> . CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that each spill container was tested in accordance with Calr'forr is Code of <br /> Regulations, title 23, division 3, chapter 16, section 2637.1; that required supporting <br /> documentation is attached; and all information oontained herein is accurate. l understand <br /> that test procedures shalt be made available upon request by the governing audrority. � <br /> Service h idan Signature Date To of Pages <br /> CERS = California Environmental Reporting System, ID = IdentTication, ICC = Internationall Code <br /> Council <br /> Page 1 of <br />