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Appendix VIII <br />Underground Storage Tank <br />Spill Container Testing Report Form <br />CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br />Council <br />Page 1 of 2 <br />TYPE OF ACTION Installation Repair 12 Month <br />1. FACILITY INFORMATION <br />CERS ID <br />10180759 <br />Test Date <br />4/17/2024 <br />Facility Name <br />AXIS MSO #6822 <br />Facility Address <br />2132 MARIPOSA RD <br />City <br />STOCKTON <br />ZIP Code <br />95205 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />TANK-TEK ENVIRONMENTAL CORP <br />Phone <br />951.779.4999 <br />Mailing Address <br />P.O BOX 5850, RIVERSIDE CA 92517 <br />Service Technician Performing Test <br />ROBERT SLUNAKER <br />Contractor/Tank Tester License Number <br />803705 <br />ICC Number <br />8041107 <br />ICC Expiration Date <br />7/8/2024 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />OPW VR-102 CERT #0174624 8/13/2024 <br />PHIL-TITE VR-101 CERT #1009833708 7/29/2024 <br />CNI VR-104 CERT #4081 3/13/2025 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used Components Tested <br />OPW VR-102 ALL SPILL CONTAINERS <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 Signature Date <br />4/17/2024 <br />Total # of Pages <br />2