Laserfiche WebLink
Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair <br />12 Month <br />1. FACILITY INFORMATION <br />CERS ID 10180955 <br />Test Date 6/4/2024 <br />Facility Name EXPRESS FUEL AND MART <br />Facility Address 701 E. CHARTER WAY <br />City <br />STOCKTON <br />de <br />95206 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />ECO - C H E K <br />Phone <br />888-500-CHEK <br />Mailing Address 3249 MT. D IABLO CT. LAFAYETTE CA 94549 <br />Service Technician Performing Test <br />Zane Nimmo <br />Contractor/Tank Tester License Number 04.1676 EX. 4/30/2025 <br />ICC Number <br />8883064 -UT <br />ICC Expiration Date <br />5/27/2025 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Franklin Fueling - EBW & Phil Tite #10009843708 <br />12/5/2024 <br />OPW #104-632 <br />3/10/2026 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />LAKE TESTING <br />SPILL BUCKET , DRAIN VALVE AND ADAPTER <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that each spill container was tested in accordance with California Code of <br />Regulations, title 23, division 3, chapter 16, section 2637.1; that required supporting <br />documentation is attached; and all information contained herein is accurate. I understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature Date 6/4/2024 <br />-> <br />Total # of Pages <br />2 <br />CERS =California Environmental Reporting System, ID =Identification, ICC =International Code <br />Council <br />Page 1 of 2 <br />