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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair 12112 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID 10181307 Test Date 10/21/24 <br /> Facility Name MANTECA FUEL <br /> Facility Address CityE MAIN ST City MANTECA 95337 ZIP e <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test NOR-CAL TANK TESTING Phone <br /> 209-712-6366 <br /> Mailing Address 877 BATEMAN WAY GALT CA 95632 <br /> Service Technician Performing Test DAV I U WINKLE R <br /> Contractor/Tank Tester License Number08-1739 Ex.2/28/26 <br /> ICC Number ICCICC Expiration Date <br /> 01/30/26 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - EBW & Phil Tite # 240924345 11/28/24 <br /> OPW #104-633 03/10/26 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> LAKE TEST ALL FILL BUCKETS <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 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 Sianature Date 10/21/24 Total # of Pages <br /> w 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />