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Appendix Vill <br /> Underground Storageg Tank <br /> ' ill Container Testing Report For <br /> TYPE OF ACTION M Installation 0 Repair F 12 Month <br /> i <br /> FACILITY INFORMATION <br /> CERS ILS _ Test Date <br /> 10104905 3/3/2022 <br /> Facility dame <br /> Central Gas <br /> Facility Address City ZIP Code <br /> 610 S . Cherokee Ln Lodi 95240 I <br /> 2 . 'SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Elite IV Contractors (209 ) 46116337 <br /> Mailing Address — <br /> 2535 ilii wamm Dr. Stockton CA <br /> Service Technician Performing Test <br /> A.dri n odd ue <br /> Contractor/Tank Tester License Number <br /> 1001331 <br /> ICC Number ICC Expiration Date <br /> 9914593 _ _ 4/27/2023 <br /> '. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW UST 019239 5119/2023 <br /> UST Service Tech 9914593 4127/2023 <br /> 4. TESD' PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested 1 <br /> Industry standard 91 OPW spill container <br /> Industry standard 01 OPW spill container' <br /> 5 . CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that each spill container was:tested in accordance with California Cade of <br /> Regulations, title' ,23, division '. apter 96, sl <br /> 'on 237. 1 ; that required supporting <br /> is attac o and all informationontained herein is accurate, I understand <br /> that test procedure • hall be made ; availab upon request by ` fhegcverning authority. <br /> Seri/ ice Technici +re — Date Total ,# of Mages <br /> �- 3/312022 2I <br /> I <br /> a ornia viron'mental Reporting ' Systern ,, ID = Identification , ICC = International Code <br /> Council <br /> Page 1 of 2 <br /> i <br />