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□ Installation □ Repair 0 12 MonthTYPE OF ACTION <br />1. FACILITY INFORMATION <br />2. SERVICE TECHNICIAN INFORMATION <br />4. TEST PROCEDURE INFORMATION <br />■ <br />Page 1 of 2 <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />ICC Number <br />8361393 <br />Facility Address <br />755 S. TRACY BLVD <br />Facility Name <br />CHEVRON #208117 <br />Date <br />02/07/2024 <br />Test Date <br />02/07/2024 <br />Phone <br />800-964-1250 <br />Total # of Pages <br />2 <br />Company Performing the Test <br />Tanknology, Inc. <br />CERS ID <br />10182313 <br />Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />ZIP Code <br />95376 <br />ICC Expiration Date <br />05/16/2025 <br />Test Procedures Used <br />Vacuum test <br />Mailing Address <br />11000 N Mopac Expy #500 Austin, TX 78759 <br />Service Technician Performing Test <br />Jesus Saldivar <br />Contractor/Tank Tester License Number <br />743160 <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />/ 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 />Components Tested <br />Spill buckets <br />Expiration Date <br />01/04/2025 <br />3. TRAINING AND CERTIFICATIONS______________ <br />Manufacturer and Test Equipment Training Certifications <br />OPWEVR Phase 1 <br />City <br />TRACY