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Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ❑ Installation 0 Repair ❑ 6 Month ❑ 36 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10180873 <br />Test Date <br />06/13/2025 <br />Facility Name <br />Jamar Service <br />Facility Address <br />4075 E. Main St. <br />City <br />Stockton <br />ZIP Code <br />95215 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Elite IV Contractors <br />Phone <br />(209)-461-6337 <br />Mailing Address <br />2535 Wigwam Dr. Stockton, CA. 95205 <br />Service Technician Performing Test <br />Ernesto Esqueda <br />ContractorlTank Tester License Number <br />1001331-A <br />ICC Number <br />10399647 <br />ICC Expiration Date <br />03/19/2027 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Modern <br />06/13/2025 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Pressure <br />91 Annular <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />1 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 Date <br />06/13/2025 <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 />