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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ® 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10180759 4/16/2025 <br /> Facility Name <br /> AXIS #6822 <br /> Facility Address City ZIP Code <br /> 2132 MARIPOSA RD STOCKTON 95205 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> TANK-TEK ENVIRONMENTAL CORP 951.779.4999 <br /> Mailing Address <br /> P.O BOX 5850 RIVERSIDE CA 92517 <br /> Service Technician Performing Test <br /> ROBERT SLUNAKER <br /> Contractor/Tank Tester License Number <br /> 803705 <br /> ICC Number ICC Expiration Date <br /> 8041107 3/4/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW VR-102 CERT #0174624 8/13/2026 <br /> PHIL-TITE VR-101 CERT #1009833708 7/19/2026 <br /> C N I VR-104 CERT #4081 3/21/2027 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> OPW VR-102 ALL SPILL CONTAINERS <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that each spill container was tested 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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 4/16/2025 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />