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ponan n this form accommodates, additional copies of this page may be attached CERS = Caftria Envuorsrrertal Reporting System, ID= identification, UST= Underground Storage Tanis ICC = International Code Council UNDERGROUND STORAGE TANK SPILL CONTAINER TESTING REPORT FORM (Page 1 of 1) Type of Action ❑ Installation Test ❑ Repair Test Z 12 Month Test I. FACILITY INFORMATION CERS ID Date of Spill Container Test 10180637 2/21 /2019 Business Name (Same as Facility Name or DBA -Doing Business As) GEMCO RIPON TRUCK PLAZA Business Site Address City ZIP Code 1022 S. FRONTAGE ROAD RIPON, CA 95366 II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as drown on the /CC Celcation.) Phone # ZANE NIMMO (209) 744-0112 Contractor I Tank Tester License # ICC Certification # ICC Certification Expiration Date 04-1676 Ex. 3/31/19 8883064 -UT 6/1/2019 Spill Container Testing Training and Certifications (List applicable certifications.) Franklin Fueling - EBW & Phil Tite #10009843708 Ex. 11129/2020 OPW #104632 Ex. 3/14/2020 III. SPILL CONTAINER TESTING INFORMATION Test Method Used: 0 Manufacturer Guidelines (Specify): O P W PHASE I LAKE TESTING ❑ Industry Code or Engineering Standard (Specify): ❑ Engineered Method (Specify): Attach the testing procedures and all documentation required t0 detelmine ffie resu/ts. # of Attached Pages TANK ID: (By tank number, stored product, etc.) 1 - 87 OCt 2 - 91 OCT Spill Container Manufacturer: O P W O P W Method of Cathodic Protection: 0Non-Metallic 0 Non -Metallic 0 Non -Metallic ❑ Non -Metallic ❑ Isolation ❑ Isolation ❑ Isolation ❑ Isolation ❑ Other (specify in V.) ❑ Other (specify in v) ❑ Other (Specify m v) ❑ Other (Speciry in v) Inside Diameter of Spill Container. (Inches) 11 11 Depth of Spill Container: (inches) 13 1 /2 14 1/2 Does the spill container have a 5 gallon capacity? 21 Yes ❑ No ® Yes ❑ No ❑ Yes ❑ No ❑ Yes ❑ No Method to Keep Spill Container Empty: 0 Drain Valve 0 Drain Valve Drain Valve ❑ Drain Valve ❑ Onsite Pump ❑ Onsite Pump ❑ Onsite Pum Pump ❑ Onsite Pump ❑ Other (Specify in V.) ❑Other (Specify in V.) ❑Other (Specify in V.) ❑Other (Specify in v) IV. SUMMARY OF TESTING RESULTS Spill Container Test Results: 0 Pass ❑Fail m Pass ❑ Fail I ❑ Pass ❑Fail ❑Pass ❑ Fail V. COMMENTS Any items marked "Fail" above must be explained in this section. Any additional comments may also be provided here. VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the spill containers were tested in accordance with California Code of Regulations, Title 23, Division 3, Chapter 16, Section 2637.1 and all the information contained herein is accurate. UST Service Technician Signature If Me fariliry Ime mn.e Com is the -- ponan n this form accommodates, additional copies of this page may be attached CERS = Caftria Envuorsrrertal Reporting System, ID= identification, UST= Underground Storage Tanis ICC = International Code Council