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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑Installation ❑Repair x12 Month <br /> 1. FACILITY INFO MATION <br /> CERS ID Test Date <br /> 10402351 10/1012024 <br /> Facility Name <br /> ARCO amlpm #83 30 <br /> Facility Address City ZIP Code <br /> 1340 W Colony Rd Ripon 95366 <br /> 2. SERVICE TECH 14 ICIAN INFORMATION <br /> Company Performin 3 the Test Phone <br /> Diamond Petrolleurn Services, Inc. (925)470-0803 <br /> Mailing Address <br /> 3619 King Ct Antio h, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> F1C—on,tractorfTank <br /> Te ter License Number <br /> 004" <br /> ICC Number ICC Expiration Date <br /> 6250451 04/01/2025 <br /> 3. TRAINING AND ERTIFICATIONS <br /> Manufacturer and T st Equipment Training Certifications Expiration Date <br /> OPW Phase UST VR # 0163755 06/06/2025 <br /> FFS EVR Phase I -101 # 1031393709 02118/2026 <br /> 4. TEST PROCED RE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatict Test 87,91 and Diesel Fill Spill Buckets <br /> S. 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 2 3, division 3, Chapter 16, section 2637.1;that required supporting documentation is <br /> attached; and all information contained herein is accurate.1 understand that test procedures shall be <br /> made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 10/10/2024 2 <br /> 6. SPILL CONTA]h ER DETAI <br /> Test Method Developed by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />