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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month 36 Month <br /> 1 . i FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181481 2022-05- 18 <br /> Facility Name <br /> Manteca CA FO REGEN <br /> Facility Address City ZIP Code <br /> 2551 E . Louise Ave . Lathrop 95330 <br /> 2 . SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> SunWest Engineering Constructors Inc 888 588 - 8737 <br /> Mailing Address <br /> 4780 Cheyenne Way , Chino CA 91710 <br /> Service Technician Performing Test <br /> Leonardo Aguilar , Jr . <br /> Contractor/Tank Tester License Number <br /> 703190 <br /> ICC Number ICC Expiration Date <br /> 5302718 12 -02-2023 <br /> 3 . TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> FFS Sump Test System Operation INCON Level 4 10/25/2023 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Industry Standard All secondary containment components <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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 2022 -05 - 18 5 <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 />