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UNDERGROUND STORAGE TANK <br /> SPILL CONTAINER TESTING REPORT FORM (Page 1 of 1 ) <br /> Type of Action ❑ Installation Test ❑ Repair Test 0 12 Month Test <br /> I . FACILITY INFORMATION <br /> CERS ID Date of Spill Container Test <br /> 10181461 6/26/2019 <br /> Business Name (Same as Facility Name or DBA-Doing Business As) <br /> Vanco Truck and Auto Plaza <br /> ZIP Code <br /> Business Site Address City <br /> 1033 W Charter Way Stockton 95206 <br /> II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Phone # <br /> Hank Moore ( 209 ) 461 -6337 <br /> Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date <br /> 8833245 9/25/2019 <br /> Spill Container Testing Training and Certifications (List applicable certifications.) <br /> 1011473708 <br /> III . SPILL CONTAINER TESTING INFORMATION <br /> Test Method Used : ❑ Manufacturer Guidelines (Specify): <br /> Hydrostatic 0 Industry Code or Engineering Standard (Specify): <br /> ❑ Engineered Method (Specify): <br /> # 7olAltacledes <br /> Attach the testing procedures and all documentation required to determine the results. <br /> TANK ID : (By tank number, stored product, etc.) Diesel N Diesel S 87 91 <br /> Spill Container Manufacturer: <br /> Method of Cathodic Protection: ❑ Non-Metallic ❑ Non-Metallic ❑ Non-Metallic ❑ Non-Metallic <br /> ❑X Isolation 9 Isolation ❑X Isolation [E Isolation <br /> ❑ Other (Specify in V) ❑ Other (Specify in V.) ❑ Other (Specify in V.) ❑ Other (Specify in V.) <br /> Inside Diameter of Spill Container: (Inches) <br /> 12 " 12 " 12 ° 12 " <br /> Depth of Spill Container: (Inches) 15 15 ` � �� 11-4 ii <br /> Does the spill container have a 5 gallon capacity? 0 Yes El No Q Yes ❑ No ZYes [:1 No R Yes [I No <br /> Method to Keep Spill Container Empty: ❑x Drain Valve Drain Valve 0 Drain Valve Q Drain Valve <br /> ❑ Onsite Pump ❑ Onsite Pump ❑ Onsite Pump ❑ Onsite Pump <br /> j <br /> El Other (Specify in V.) El Other (Specify in V.) <br /> E] Other (Specify in V) E] Other (Specify in V.) <br /> IV. SUMMARY OF TESTING RESULTS <br /> Spill Container Test Results : ED Q Fail O Pass ❑ Fail 99 Pass El Fall El Pass ❑ Fail <br /> V. COMMENTS <br /> Any items marked `Fail " above must be explained in this section. Any additional comments may also be provided here. <br /> Failure of diesel trough drain <br /> VI . CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> I hereby certify that the spill containers were tested in accordance with California Code of Regulations , Title 23 , Division 3 , <br /> Chapter 16 , Section 2637.1 and all the Information contained herein is accurate. <br /> UST Service Technician Signature / <br /> If the facility has more components than this form accommodates, additional copies of this page may be attached. <br /> CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council <br />