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I%Al^ Vol <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION F1 Installation KRepair D 6 Month 97 36 Month <br />1. FACILITY INFORMATION <br />........... <br />CERS ID TestDate <br />10181267 121212021 <br />--- - ------------ <br />Facility Name <br />Stockton AASF <br />..... . ...... ...... .... <br />..... . .......... <br />Facility Address City ZIP Code <br />2000 Stimson RD <br />Stockton 95206 <br />2. SERVICE TECHNICIAN INFORMATION <br />. . . . ............... ­­­ ........... ­­ ­­. . . ................ <br />Company Performing the Test <br />Phone <br />Tank Team, inc <br />432-0216 <br />Mailing Address <br />-(805} <br />2745 Sherwin Ave, Ste. 3, Ventura, CA 93003 <br />............... ­-­------------------ .... . .......... _. -------- <br />Service Technician Performing Test <br />Bernard Olson <br />Contractor/Tank Tester License Number <br />512835 Eng A, C-10- C-57 HAZ <br />- - --------­--­--- . . . .. . .................. . ..... ­­ .......................................... ........... ........... <br />ICC Number <br />ICC Expiration Date <br />5252993 LIT <br />8/17/2023 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications . <br />Expiration Date <br />Incon STS, 10000103709 <br />...... . .... . ........... ... . ..... . . . ...... ....... . ....... ....... <br />.......... 12/22/2021 <br />14. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />. . . . . ............. ... . ........ ....... ­-­ ... ............................ .. . .......... ............................ . ............ <br />Components Tested <br />PEI RP 1200 Section 6.2 <br />. . .... . ...... ........... .................................. <br />............. .......... ....... ............. .. . .......... ............... ............. .................. <br />AST to Bulk Reel UDC <br />.. . . ...................................... .................... ................. <br />.................... .. ..... .. .. ... ..... ..... <br />. . . ...... . ............. <br />.... . . ...... - ----- <br />- ------ ------ <br />........... . ....... . . -- <br />F6. CERTIFICATi6li"BYERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that the secondary containment was tested in accordance with California <br />Code of Regulations, title 23, division 3, chapter 16, section 2637; 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 />---------­--­----- ­­­ - - - — --------- __j <br />Service Techni ign Date Total # of Pages <br />12/11/2021 <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispenser Containment,_ <br />