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Appendix VII SA-30575 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10141507 2023-08-16 <br /> Facility Name <br /> Manteca CO <br /> Facility Address City ZIP Code <br /> 430 W Center St Manteca 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> SunWest Engineering Constructors Inc 888 588-8737 <br /> Mailing Address <br /> 4780 Cheyenne Way, Chino CA 91710 <br /> Service Technician Performing Test <br /> Leonardo Aguilar, Jr. <br /> Contractor/Tank Tester License Number <br /> 703190 <br /> ICC Number ICC Expiration Date <br /> 5302718 12/2/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> INCON TS-STS 10/21/23 <br /> JOOR 2/6/24 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> PEI/RP 1200 All secondary containment components <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the secondary containment was tested in accordance with California <br /> Code of Regulations, title 23, division 3, chapter 16, section 2637, 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 /> 2023-08-16 7 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 7 <br />