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Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair 0 12 Month <br />1. FACILITY INFORMATION <br />CERS ID Test Date <br />10180631 6/4/2025 <br />Facility Name <br />Duik Stop Market <br />Facility Address City ZIP Code <br />1721 S. Cherokee Lane Lodi 95240 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Walton Engineering <br />Mailing Address <br />3900 Commerce Drive, West Sacramento <br />Service Technician Performing Test <br />Anthony Reyes <br />Contractor/Tank Tester License Number <br />617238 <br />Phone <br />916 373 1166 <br />ICC Number ICC Expiration Date <br />3293772 07-30-2026 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />OPW Phase 1 103920 <br />02-13-2027 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Hydrostatic <br />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 <br />Anthony Reyes <br />Date <br />6/4/2025 <br />Total # of Pages <br />2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Page 1 of 2 <br />