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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form R E C E W E <br /> TYPE OF ACTION ❑Installation ❑Repair x12 Month OCT 2 3 2020 <br /> 1. FACILITY INFORMATION bp At TWI <br /> CERS ID TPItfP,'SERVICES <br /> 10402351 10/22/2020 <br /> Facility Name <br /> ARCO am/pm # 83230 <br /> Facility Address City ZIP Code <br /> 1340 W Colony Rd Ripon 95366 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Diamond Petroleum Services, Inc. (925)470-0803 <br /> Mailing Address <br /> 3619 King Ct Antioch, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> Contractor/Tank Tester License Number <br /> ICC Number ICC Expiration Date <br /> 5250451 04/0412021 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW EVR UST VR-102 06/07/2021 <br /> FFS EVR Phase I VR-101 03/04/2022 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatict Test 87,91 and Diesel Fill Spill Buckets <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 2637.9;that required supporting documentation is <br /> attached;and all information contained herein is accurate./understand that test procedures shall be <br /> made available upon request by the governing authority. <br /> Service Technician Signature Date Total# of Pages <br /> 10/22/2020 2 <br /> 6. SPILL CONTAINER DE AILS <br /> Test Method Developed by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />