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00"V6 w 911 <br />Appendix VIII <br />Underground Storage Tarty <br />Spill Container Testing Report Fora <br />TYPE OF ACTION r Installation W Repair ❑ 12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10180741 <br />Certification Date <br />07/03/2023 <br />Facility Name <br />Manteca Liquor & Food <br />Facility Address <br />890 N. Main St. <br />City <br />Manteca <br />County <br />n oa uin <br />Zip Code <br />5336 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Certification <br />Elite IV Contractors <br />Phone <br />209 461-6337 <br />Mailing Address <br />2535 Wigwam Dr Stockton CA <br />Contractor/Tank Tester License <br />Number 1001331 <br />Service Technician Performing Test <br />Michal Kennard <br />ICC Number <br />Sb75�si! <br />ICC Expiation Date <br />7 to as <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer & Test Equipment Training Certifications <br />Expiration Date <br />OPW Phase 1 UST <br />06/30/2025 <br />Modern Welding Tank Installers <br />03/03/2026 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Component(s) Tested <br />Hystostatic <br />Diesel Spill Container <br />Vacuum <br />Diesel Tank Secondary Containment <br />5. CERTIFICATION BY THE SERVICE TECHNICIAN CONDUCTING THE TEST <br />I hereby certify Mat each spill container was tested in accordance with Califomie Code of <br />Regulations, fide 23, division 3, chapter 16, section 2637.1; that required supporfing doc umeniadon <br />is attached,• and all infonnafion contained herein is accurate. I understand that test procedures shall <br />be made available upon request by the goveming authority. <br />Service Technician Signature <br />'V - <br />Date <br />07/03/2023 <br />Total # of Pages <br />3 <br />CELS= California Environmental Reporting System, GPH= Gallons Per Hour, ICS= Identification, ICC= <br />International Code Council <br />