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Appendix Vill <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ® Installation ❑ Repair ❑ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID 10181303 Certification Date <br /> 12/15/2023 <br /> Facility Name <br /> Stockton Auto Center Carwash <br /> Facility AddressCounty Zip Code <br /> City <br /> 3434 Hammer Ln Stockton San Joaquin 95212 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Elite N Contractors 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 /> Benjamin Malaspina <br /> ICC Number ICC Expiration Date <br /> 9519380 06/17/2024 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer& Test Equipment Training Certifications Expiration Date <br /> FFS EVR Phase 1 10/23/2025 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Component(s) Tested <br /> Hydrostatic 87, 91 & Diesel Bucket <br /> 5. CERTIFICATION BY THE SERVICE TECHNICIAN CONDUCTING THE TEST <br /> 1 hereby c er*that each spill container was tested in accordance with Caldomia Code of <br /> Regulations, 0e 23, division 3, chapter 16, section 2637.1,Mat required supporting documentation <br /> is attached, and all Information contained herein is accurate. /understand Ghat test procedums shall <br /> be made available upon request by the goveming au6ioMy. <br /> Service Technician Signature Date Total #of Pages <br /> Z��Al-r— � 12/15/2023 2 <br /> CERS= California Environmental Reporting System, GPH= Gallons Per How, ID= Identification, ICC= <br /> International Code Council <br />