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Appendix 8 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair ® 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10180781 1-28-26 <br /> Facility Name <br /> United Pacific #5447 <br /> Facility Address City ZIP Code <br /> 1469 E Hammer Lane Stockton 95210 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing =RS Phone <br /> CGRS, Inc. (916)991-1100 <br /> Mailing Address <br /> 5444 Dry Creek Road, Sacramento, CA. 95838 <br /> Service Technician Performing Testing <br /> Garrett Warren <br /> Contractor License Number <br /> CSLB #803616 <br /> ICC Certification ICC Expiration Date <br /> 8185019 10-17-26 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> F.F.S. Incon Level 4 TS-STS Sump Testing Cert. #1000553709 10-3-27 <br /> Omntec Sump tester Cert#GW4576689 4-19-27 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> RP-1200 / Manufacture's IOM Tank Annulars, Product Line Secondaries, Tank Top Sumps & UDCs <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the secondary containment was tested in accordance with California <br /> Code of Regulations, title 23, division 3, chapter 16, section 2666; that required supporting <br /> documentation is attached; and all information contained herein is accurate. 1 understand <br /> that test procedures must be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> Garrett Warren 1-28-26 7 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment <br /> Page 1 of 4 <br />