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<br />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 /> <br />Page 1 of 2 <br />TYPE OF ACTION ☐☐☐☐ Installation ☐☐☐☐ Repair ☒☒☒☒ 12 Month <br />1. FACILITY INFORMATION <br /> <br />CERS ID <br />10184915 <br />Test Date <br />11/20/2024 <br /> <br />Facility Name <br />Kesar Petroleum Inc. <br /> <br />Facility Address <br />717 W Eighth St. <br />City <br />Stockton <br />ZIP Code <br />95206 <br /> <br />2. SERVICE TECHNICIAN INFORMATION <br /> <br />Company Performing the Test <br />Pinnacle Fuel Compliance <br />Phone <br />408-206-9840 <br /> <br />Mailing Address <br />P.O. Box 32849 <br />Service Technician Performing Test <br />Jeff Conger <br />Contractor/Tank Tester License Number <br />90-1116 <br /> <br />ICC Number <br />1081782 <br />ICC Expiration Date <br />11/01/2026 <br /> <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications Expiration Date <br />FFS EVR Phase I – VR101 (Phil-tite) #1020003708 3/5/2025 <br />OPW #104789 3/8/2025 <br /> <br /> <br />4. TEST PROCEDURE INFORMATION <br /> <br />Test Procedures Used Components Tested <br />PEI 1200 Spill bucket integrity <br />FFS EVR Phase I Spill bucket integrity <br /> <br /> <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 /> <br />Service Technician Signature <br /> <br />Date <br />11/20/2024 <br />Total # of Pages <br />2 <br />