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Appendix VII 198220 <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION Flinstallation FIRepair 1:16 Month 736 Month <br />1.;, FACILITY INFORMATION 71 <br />CERS ID <br />10181235 <br />Test Date <br />5/21/2025 <br />Facility Name <br />Arco 5450 <br />Facility Address <br />1617 W. Fremont <br />City <br />Stockton <br />ZIP Code <br />95203 <br />2.SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Nwestco LLC <br />Phone <br />925-551-7444 <br />Mailing Address <br />6805 Sierra Court, Suite G, Dublin, CA 94568 <br />Service Technician Performing Test <br />Jaycee Cornett <br />Contractor/Tank Tester License Number <br />1073967 <br />ICC Number <br />10421744 <br />ICC Expiration Date <br />8/16/2026 <br />3.'' TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Incon Level 4 Sump Testing Tech Cert #5419343715 <br />7/26/2025 <br />4.` TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Hydrostatic <br />All Sumps & UDC's <br />Vacuum <br />All Annular Tanks <br />Pressure <br />All Secondary Lines <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that the secondary containment was tested in accordance with California <br />Code of Regulations, title 23, division 3, chapter 16, section 2637; 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 <br />Date <br />5/21/2025 <br />Total # of Pages <br />5 <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, <br />Page 1 of 5 <br />