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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION © Installation © Repair X 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181351 5/25/2022 <br /> Facility Name <br /> Chevron 8660 <br /> Facility Address City ZIP Code <br /> 8660 N Lower Sacramento Rd Stockton 95210 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> IEC Services (916) 993-6312 <br /> Mailing Address <br /> 4901 Warehouse Way, Sacramento, CA 95826 <br /> Service Technician Performing Test <br /> Henry Olvera <br /> rio <br /> tractor/Tank Tester License Number <br /> 4168 <br /> ICC Number ICC Expiration Date <br /> 9796545 9/1/2022 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW - 0176686 01/25/23 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic All fill spill buckets <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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Sign Date Total # of Pages <br /> 5/25/2022 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />