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Annual Spill Container Testing on 9/30/21 for Bank of Stockton Airport <br /> Appendix Vill <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION Ej Installation ® Repair ® 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181291 9/30/2021 <br /> Facility Name <br /> Bank of Stockton Airport <br /> Facility Address City ZfP Code <br /> 1941 E Lockheed Court Stockton 95206 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> 1001331 (209) 461-6337 <br /> Mailing Address <br /> Elite IV Contractors <br /> Service Technician Performing Test <br /> Joe Bartholdi <br /> Contractor/Tank Tester License Number <br /> 1001331 1 A-Hazmat <br /> ICC Number ICC Expiration Date <br /> #2851 4/13/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW Spill Container #100782 5/20/2023 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic Spill Bucket on Fill <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 2637.1; that required supporting <br /> documentation is attached; and all information contained herein is accurate. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Tech is naturey Date Total # of Pages <br /> 9/30/2021 2 <br /> CERS California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />