Laserfiche WebLink
□ RepairTYPE OF ACTION □ Installation 0 12 Month <br />Facility Name CHEROKEE ARCO <br />03/10/24 <br />LAKE TEST <br />Page 1 of 2 <br />Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />ZIP Code <br />95205 <br />ICC Expiration Date <br />01/30/24 <br />Total # of Pages <br />2 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />3. TRAINING AND CERTIFICATIONS ______________________ <br />Manufacturer and Test Equipment Training Certifications <br />Franklin Fueling - EBW & Phil Tite # 240924345 <br />OPW #104-633 <br />Expiration Date <br />11/28/24 <br />5. 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 Sianature I Date 12/20/23 <br />______________________________________ <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Phone <br />209-744-0112 <br />Test Date <br />12/20/23 <br />Components Tested <br />ALL FILL BUCKETS <br />Facility Address3443 C|-|ER0KEE RD C"y STOCKTON <br />ICC Number 8883059-UT <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test . AffordaTest <br />1. FACILITY INFORMATION <br />CERSID10830655 <br />Mailing Address 41g CA <br />Service Technician Performing Test Qgyjj \/\/jp||^|0p <br />Contractor/Tank Tester License NumberQg 73Q EX 3/31/26