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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTIO ❑Installation ❑Repair x12 Month <br /> 1. FACILITY INFOI MATION <br /> CERS ID Test Date <br /> 10422475 03/25/2024 <br /> Facility Name <br /> Yosemite Avenue ARCO AM PM <br /> Facility Address City ZIP Code <br /> 1711 E.Yosemite Ave. Manteca 95336 <br /> 2: SERVICE TECH 41CIAN INFORMATION <br /> Company Performin 3 the Test Phone <br /> Diamond PetroleuF i Services, Inc. (925) 470-0803 <br /> Mailing Address <br /> 3619 King Ct Anti h, CA 94509 <br /> Service Technician Derforming Test <br /> Guadalupe Sanchez <br /> r0100Contractor/Tank Tester License Number <br /> 44 <br /> 544 <br /> (1 <br /> ICC Number ICC Expiration Date <br /> 5250451 04/0112025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and st Equipment Training Certifications Expiration Date <br /> OPW PHASE 1 UST EVR Tech #0163755 06/06/2025 <br /> 4. TEST PROCEDI PRE INFORMATION <br /> Test Procedures Used Components Tested <br /> PE11200/Hydrost T st 87M,87S and 91 Fill Spill Buckets <br /> 5. <br /> CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> !hereby certify that each spill container was tested in accordance with California Code of <br /> Regulations, title 2 3, division 3, chapter 16, section 2637.1;that required supporting documentation is <br /> attached;and all it iformation contained herein is accurate./understand that test procedures shall be <br /> made available upon request by the governing authority. <br /> Service Technician 3ignature Date Total #of Pages <br /> 03/25/2024 2 <br /> 6. SPILL CONTAM ER DETAILSf <br /> Test Method Develc ped by ❑ Manufacturer x Industry Standard ❑ Professional Engineer <br /> CERS = CaliforniaEnvironmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />