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Appendix <br />Underground Storage Tank <br />Spill Containment Testing Deport Form <br />TESTING TYPE 0 Installation 0 Repair d 12 Month <br />1. FACILITY INFORMATION <br />CERS ID Test Date <br />10180733 6110/2026 <br />Facility Name <br />Arco 7'147 <br />Facility Address I City <br />1206 E. March Lane Stockton <br />ZIP Code <br />95210 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing Testing <br />Phone <br />Nwestoo LLC dba Gelder -Ryan <br />925-55147555 <br />Mailing Address <br />6805 Sierra Court, Suite G, Dublin, OA 94568 <br />Service Technician performing Testing <br />Gabriel Solodo <br />Contractor License Number <br />1073967 <br />ICC Certification <br />ICC Expiration Date <br />104 5282 <br />19/1412026 <br />3. TRAINING AND CERTIFICATION <br />Manufacturer and Test Equipment Training Certifications <br />Training Expiration [date <br />OP1VV EAST EVR Phase 1 Tech Cert #1193597 <br />1912027 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />1 Four Hydrostatic <br />All Spill Buckets <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that each spill containment was tested in accordance with California Coale of <br />Regulations, title 23, division 3, chapter 96, section 2864; that required supporting <br />documentation is attached; and ail information contained herein is accurate. i understand <br />that fest procedures must be made available upon reguest bar the governing authority. <br />Service Technician Signature mate Total # of Pages <br />611012025 <br />CER = alifcrnia Er�vironme tall Reporting System, IOC - International Code Council, <br />ID = Identification <br />Page 1 of 2 <br />