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210209-530 <br /> Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ® 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10403278 03/02/21 <br /> Facility Name <br /> Lodi CA FO Term (Intl) <br /> Facility Address City ZIP Code <br /> 2500 West Turner Road Lodi 95242 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> SunWest Engineering Constructors, Inc. (888) 588-8737 <br /> Mailinq Address <br /> 4780 Cheyenne Way, Chino, CA 91710 <br /> Service Technician Performing Test <br /> Kraig Kinder <br /> Contractor/Tank Tester License Number <br /> CA-703190 <br /> ICC Number ICC Expiration Date <br /> 8296393 11/18/22 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling 5/29/22 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Industry Standard PEI-RP-1200-12 <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> l 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 Total # of Pages <br /> Digitally signed by Kraig Klnaer <br /> Kraig Kinder O1.2021 03 02 11 3F,05 03/02/21 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />