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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION L�- installation U RGPair AI 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10770799 04/24/2025 <br /> Facility Name <br /> 7-Eleven 38153 <br /> Facility Address City ZIP Cade <br /> 121 S. Center Street Stockton 95202 <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 05/16/2025 <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 Testers <br /> vacuum/leak test spill buckets <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I 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 test procedures shall be made available upon request by the governing authority. <br /> Service T chnician Signature Date Total # of Pages <br /> 04/24/2025 2 <br /> CERS = California Environmental Reporting System: ID = Identification, [CC = Internationa# Code <br /> Council <br /> Page 1 of 2 <br />