Laserfiche WebLink
Appendix 6 <br /> Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair x 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181463 2/24/2026 <br /> Facility Name <br /> Village West Marina <br /> Facility Address City ZIP Code <br /> 6649 Embarcadero Drive Stockton 95219 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Diamond Petroleum Services, Inc. 925 470-0803 <br /> Mailing Address <br /> 3619 King Ct Antioch, CA 94509 <br /> Service Technician Performing Testing <br /> Guadalupe Sanchez <br /> Contractor License Number <br /> 100544 <br /> ICC Certification ICC Expiration Date <br /> 5250451 3/22/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> QPW Phase 1 UST EVR Tech # 0163755 6/10/2027 <br /> 4, TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic Test 91 and Diesel Fill Spill Buckets <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <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 nest by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> r� 2/24/2026 2 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification <br /> Page 1 of 2 <br />