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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 10181019 Test Date <br /> 11/14/2024 <br /> Facility Name TRACY MARKET <br /> Facility Address 15 E. G RANTLI N E RD city TRACY ZIP Code <br /> 95376 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> ECO CHEK COMPLIANCE INC 415 399- 9602 <br /> Mailing Address P.O. BOX 1394, Lafayette, CA 94549 <br /> Service Technician Performing Test Ed Stearns <br /> Contractor/Tank Tester License Number 14-1760 <br /> ICC Number 8883080_UT ICC Expiration Date <br /> 11/6/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - EBW & Phil Tite #1009893708 11/26/2024 <br /> OPW #104-635 3/4/2026 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> LAKE TEST SPILL BUCKETS <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 11/14/2024 Total # of Pages <br /> (9-,t*frd Otte 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />