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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair V 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181431 8-16-2022 <br /> Facility Name <br /> Manteca Valero <br /> Facility Address City ZIP Code <br /> 1700 E. Yosemite Ave. Manteca 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Tank-Tight Systems, Inc. (916)378-4167 <br /> Mailing Address <br /> 1729 Crystal Ct., Olivehurst, CA 95961 <br /> Service Technician Performing Test <br /> Brian Roth <br /> Contractor/Tank Tester License Number <br /> 1066914 A HAZ <br /> ICC Number ICC Expiration Date <br /> 8834817 11/14/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> ICC SERVICE TECHNICIAN 11/14/2023 <br /> VAPOR RECOVERY INSTALLATION AND REPAIR 11/27/2023 <br /> OPW EVR PHASE 1 10/21/2023 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> HYDROSTATIC W/ 87,91 Spill Buckets <br /> MEASUREMENTS <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 Signature Date Total # of Pages <br /> A�� 8-16-2022 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />