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Appendix Vill <br /> Underground Storage Tank <br /> TYPE OF ACTION 0 Installation [Z Repair E] 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10184317 08/18/2025 <br /> Facility Name <br /> Loves <br /> City County Zip Code <br /> Facility Address 1553 Colony Rd Ripon San Joaquin 95366 <br /> 2. SERVICE TECHNICIAN INFORMATION Phone <br /> Company Performing the Certification —Ph o <br /> Elite IV Contractors (209)461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr Stockton CA <br /> Contractor/Tank Tester License <br /> Number 1001331 <br /> Service Technician Performing Test <br /> Jordan Esqueda <br /> ICC Number ICC Expiration Date <br /> 10611893 07/21/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer& Test Equipment Training Certifications Expiration Date <br /> OPW Phase 1 UST 1194280 07/24/2027 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Component(s) Tested <br /> 5-Gallon Bucket Test 91 Spill bucket and drain <br /> 5. CERTIFICATION BY THE SERVICE TECHNICIAN CONDUCTING THE TEST <br /> hereby certifyMeteach spill container was tested in accordance with Calffbmia Code of <br /> Regulations, fide 23, division 3, chapter 18, section 2837.1;Mat requif ad supporting documentation <br /> Is affached, and all informadon contained herein is accurate I understand that W pmcedulm shall <br /> be made available upon faquest by the go veming authority <br /> Service Technician Signature Date Total # of Pages <br /> 7X-0&1F?1'A 08/18/2025 2 <br /> CERS= California Environmental Reporting System, GPH= Gallons Per Hour, ID= Identification, ICC= <br /> International Code Council <br />