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Appendix Vill <br /> [underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION 0 Installation ® Repair ® 12 Month <br /> I <br /> 1. FACILITY:,INFORMATION <br /> CERS ID Test nate <br /> 6/17/2021 <br /> Facility Name <br /> Hunt & Sons a Arch Road Cardlock i <br /> Facility Address City ZIP Code <br /> 4733 S. Hwy 99 Frontage Rd Stockton 95210 <br /> lF-2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Donlee Pump Company (209) 5379396 <br /> Mailing Address <br /> 2825 Railroad Ave. Ceres CA. 95307 <br /> Service Technician Performing Test <br /> Jerry Lan rell <br /> Contractor/Tank Tester License Number <br /> NIA <br /> ICC Number ICC Expiration Date <br /> 8899490 7/23/20222 <br /> 3.. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling 1 Incon 112021 <br /> Veeder Root 11120/2021 <br /> OPW 7131/2022 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tesfed <br /> 5. >CERTIFICATION.EY.SERV[CE TECHNICIAN CONDUCTING TEST <br /> 1 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 Teehn ' ' n Signature Date Total # of Pages <br /> 7f21( <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />