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Appendix 6 <br /> Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair 0 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10180943 02/06/26 <br /> Facility Name <br /> SHOP N GO <br /> Facility Address City ZIP Code <br /> 4511 PACIFIC AVE STOCKTON 95207 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Norcal Petroleum Tank Testing 209-712-6366 <br /> Mailing Address <br /> 877 Bateman way Galt Ca 95632 <br /> Service Technician Performing Testing <br /> David Winkler <br /> Contractor License Number <br /> 1115912 <br /> ICC Certification ICC Expiration Date <br /> 8883059-UT 2/2/28 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Franklin Fueling - EBW & Phil Tite # 1009853708 12/15/26 <br /> OPW#104-633 03/10/26 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Lake Test All Fill Buckets <br /> 15. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST I <br /> I hereby certify that each spill containment was tested in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2664; that required supporting <br /> documentation is attached, and all information contained herein is accurate. I understand <br /> that test procedures must be made available upon re uest by the governing authority, <br /> Service Technician Signature Date Total # of Pages <br /> -n"A 2/6/26 2 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification <br /> Page 1 of 2 <br />