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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month 0 36 Month <br /> 1 FACILITY INFORMATION <br /> CERS ID Test Date <br /> 1039987 1 /3/22 <br /> Facility Name <br /> Fount & Sons Inc . <br /> Facility Address City ZIP Code <br /> 4733 S . Hwy 99 Frontage Rd Stockton 95352 <br /> 2 SERVICE TECHNICIANINFORMATION <br /> Company Performing the Test Phone <br /> Donlee Pum Company 209 537 -9396 . <br /> Mailing Address <br /> 2825 Railroad Ave . Ceres CA . 95307 <br /> Service Technician Performing Test <br /> Gerardo Perez <br /> Contractor/Tank Tester License Number <br /> 432039 <br /> ICC Number ICC Expiration Date <br /> 8962656 3/14/2023 <br /> 3 TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - Incon Level 4 9/21 /22 <br /> OPW 8/26/22 <br /> EMCO 5/31 /21 <br /> 4 TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Incon Level 4 Sumps , Piping , Annular Space <br /> PEI -1200 Sumps , Piping , Annular Space <br /> 5. CERTIFICATION BY SERVICE 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. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> CERS = California Environmental Reporting System , ICC = International Code Council, <br /> ID = Identification , NA = Not Applicable , UDC = Under- Dispenser Containment, <br /> Page 1 of 5 <br />