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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 />Company Performing Testing <br />CERS ID <br />Test Date <br />10181541 <br />01-07-2026 <br />Facility Name <br />Service Technician Performing Testing <br />PACIFIC BELL TELEPHONE CO. DBA AT&T CALIFORNIA <br />Contractor License Number <br />Facility Address <br />City <br />ICC Expiration Date <br />ZIP Code <br />1812 Coley Ave. <br />Escalon <br />95320 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing Testing <br />Phone <br />TAIT Environmental Services, Inc. <br />(714) 560-8222 <br />Mailing Address <br />11280 Trade Center Dr., Rancho Cordova, CA 95742 <br />Service Technician Performing Testing <br />Darren Sciume <br />Contractor License Number <br />588098 <br />ICC Certification <br />ICC Expiration Date <br />8223550 <br />05-14-2026 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Training Expiration Date <br />FFS EVR Phase I Systems - VR -101 - Certification # 1015363709 <br />07-25-2027 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />PEI RP 1200 <br />T1 Diesel 0001OU001 Spill container <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 request by the governing authority, <br />Service Technician Signature Date Total # of Pages <br />01-07-2026 2 <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification <br />Page 1 of 2 <br />