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Appendix VIII_ RECEIVED <br /> Underground Storage Tank <br /> Spill Container Testing Report Form OCT 1 s 2022 <br /> TYPE OF ACTION ❑ Installation ❑ Repair x12 Month ENVIRONMENTAL HEALTH <br /> 1 , ..:pACILTY ififllII tctI xv , 111 . F <br /> DEPARTMENT <br /> CERS ID 7TestDate <br /> 10182265 1 /2021 <br /> Facility Namin <br /> ARCO AM PM # 82602 <br /> Facility Address City ZIP Code <br /> 2430 Joe Pombo Pkwy Tracy 95376 <br /> 2 : :SERVICE TECHNIC'AN INFO IA {QN <br /> _. , <br /> Company Performing the Test Phone <br /> Diamond Petroleum Services , Inc. ( 925j 470-0803 <br /> Mailing Address <br /> 3619 King Ct Antioch , CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> Contractor/Tank Tester License Number <br /> 1005444 <br /> ICC Number ICC Expiration Date <br /> 5250451 04/01 /2023 <br /> TI'tAllltl+l Afib GEi 'iFICATtif�S ... . . It "tr -iI <br /> t 1 ,, t <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> OPW Phase 1 UST Enhanced Vapor Recovery Tech # 0163755 06/05/2023 <br /> 4 TEST PRQGIII INItI�tMATrthl ' ; ' ,k fit <br /> i <br /> i <br /> vin till <br /> Test Procedures Used Components Tested <br /> Hydrostatict Test 87 and 91 Fill Spill Buckets <br /> ee <br /> . I~F TII 'ATIQN Yr idfAN CCN ES �, <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 documentation is <br /> attached; and all information contained herein is accurate) understand that test procedures shall be <br /> made available upon request by the governing authority. <br /> Service Technician Signature r <br /> Total # of Pages <br /> /2021 2 <br /> _. n <br /> . . . . . . .. ... . ,, , ..c . . :, ,.. . . ,.. . . l7 <br /> Test Method Developed by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = California Environmental Reporting System , ID = Identification , ICC = International Code <br /> Council <br /> Page 1 of 2 <br />