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Appendix 6 <br /> Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> TESTING TYPE IJ Installation I] Repair IZ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10182331 1/08/2026 <br /> Facility Name <br /> CHEVRON 208118 N-4087-1-3 <br /> Facility Address II City ZIP Code <br /> 3355 E. HAMMER LANE @ HOLMAN RD 6TOCKTON 95212 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing 00-964-1250 <br /> hone <br /> anknology,Inc. <br /> Mailing Address <br /> 11000 N Mopac Expy#500 Austin,TX 78759 <br /> Service Technician Performing Testing <br /> Jesus Saldivar <br /> Contractor License Number <br /> 743160 <br /> ICC Certification [CC Expiration Date <br /> 8361393 105/12/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Cert[fications Training Expiration Date <br /> Franklin Fueling:Phil-Tite EVR Ph 1 Systems 07/10/2026 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> VACUUM TEST SPILL BUCKETS <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> l 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. l understand <br /> that rest procedures must be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> { �01/08/2026 2 <br /> CERS = California Environmental Reporting System, ICC = International Code Council. <br /> ID = Identification <br /> Page 1 of 2 <br />