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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 Test Date <br /> 10165857 09/23/2025 <br /> Facility Name <br /> 7-ELEVEN#19976, MKT 2368 <br /> Facility Address City ZIP Code <br /> 1399 N. MAIN ST.@ NORTHGATE MANTECA 95336 <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 /> Benjamin Baunach <br /> Contractor/Tank Tester License Number <br /> 743160 <br /> ICG Number ICG Expiration Date <br /> 8835404 01/05/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> ICC:CA UST Service Technician 01/05/2026 <br /> LTankn <br /> EVR UST 07/28/2026 <br /> ology Certification:Level III Spill Container Testing Certification Exam 10/06/2025 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic Sb <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 263 7.1 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 Total# of Pages <br /> 09/23/2025 2 <br /> CERS = California Environmental Reporting System; ID = Identification. ICC = International Code <br /> Council <br /> Page 1 of 2 <br />