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Test Date <br />02/02/2023 <br />CERS ID <br />10181547 <br />Facility Name <br />Pacific Bell Telephone Co. dba AT&T California <br />Facility Address <br />10 E. 12th St. <br />City <br />Tracy <br />ZIP Code <br />95376 <br /> <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />TAIT Environmental Services, Inc. <br />Phone <br />(714) 560-8222 <br />Mailing Address <br />11280 Trade Center Dr., Rancho Cordova, CA 95742 <br />Service Technician Performing Test <br />Christopher Bogan <br />Contractor/Tank Tester License Number <br />588098 <br />ICC Number <br />9901042 <br />ICC Expiration Date <br />01/28/2025 <br />TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />Franklin Fueling EVR Phase I - 1002713713 01/20/2024 <br />1 <br />TEST PROCEDURE INFORMATION <br />Test Procedures Used Components Tested <br />PEI RP1200 Spill Container <br />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, <br />_ f", - - : - - <br />Date <br />02/02/2023 <br />Total # of Pages <br /> <br />Appendix VIII <br /> UE058 <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />TYPE OF ACTION <br /> <br />0 Installation ID Repair 0 12 Month <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Page 1 of 2