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Appendix Vill <br /> Underground Storage Tank <br /> �Spl € ContainerTesting e r Fore. <br /> TYPE OF ACTION ® Installation ® Repair ❑ 12Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10184317 08/18/2025 <br /> Facility Name <br /> Loves <br /> Facility Address City County Zip Code <br /> 1553 Colony Rd Ripon San Joaquin 95366 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <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 �107/21/2027 <br /> C Expiration Date <br /> 10611893 <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 cerW Mat each spill container was tested in accordance*0 Ca/ifomia Code of <br /> Regulations, We 23, division 3, chapter 16, section 2637 i;that required suppor ft documen/at/on <br /> /s attached,•and all informadon contained herein is accurate. /understand that test proeeduras shall <br /> be made available upon requeWby the goveming aulfioMy. <br /> Service Technician Signature Date Total # of Pages <br /> TordinFPA 08/18/2025 2 <br /> CERS= California Environmental Reporting System, GPH= Gallons Per Hour, ID= Identification, ICC= <br /> International Code Council <br />