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Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 36 Month <br />1. FACILITY INFORMATION <br />CERS ID Test Date <br />10184731 5/12/2025 <br />Facility Name <br />Nashir-EI Dorado, Inc. <br />Facility Address City ZIP Code <br />713 North EI Dorado Street Stockton 95202 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Duncan Compliance: Dba R&D Compliance Testing <br />Phone <br />707 621-0378 <br />Mailing Address <br />P.O. Box 1503 Ukiah Ca. 95482 <br />Service Technician Performing Test <br />Ben'amin Duncan <br />Contractor/Tank Tester License Number <br />Contractors License #1036490 <br />ICC Number <br />5246802 -UT <br />ICC Expiration Date <br />1/30/27 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Caldwell Systems/Level Change Indicator <br />3/1/26 <br />PEI/RP 1200 Certificate of Completion -PEI Service Tech <br />5/4/27-5/6/27 <br />Franklin Fueling Systems -Pro Compliance Testing <br />5/25/25 <br />XERXES Corporation -Western Fiberglass, Inc. <br />4/5/27-5/4/27 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Vacuum <br />Tank Secondary Containment <br />Pressure <br />Product/Vent/Vapor Piping Secondary Containment <br />Hydrostatic <br />Piping Sumps/UDC's/Vent Sump/Fill Sumps <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 <br />Date <br />5/12/2025 <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 />