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Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION Ll Installation LJ Repair 0 12 Month <br />1. FACILITY INFORMATION <br />CE RS ID <br />10933951 <br />Test Date <br />08/18/2025 <br />Facility Name <br />CHEVRON 99280 <br />Facility Address <br />1222 W Atherton <br />City <br />Manteca <br />ZIP Code <br />95337 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test Phone <br />Tanknology, Inc. 800-964-1250 <br />Mailing Address <br />11000 N Mopac Expy #500 Austin, TX 78759 <br />Service Technician Performing Test <br />Carlos Zaragoza <br />Contractor/Tank Tester License Number <br />743160 <br />ICG Number ICC Expiration Date <br />10400957 07/29/2026 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />ICC:CA UST Service Technician <br />07/29/2026 <br />OPW:EVR UST <br />10/02/2026 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used Components Tested <br />INDUSTRY STANDARD SB <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />1 hereby certify that each spill container was tested in accordance with California Code of <br />Regulations, title 23, division 3, chapter 16, section 263 7. 1that 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 />- <br />Date <br />08/18/2025 <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 />