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Appendix VIII <br /> Underground Storage Tank <br /> Spill Container Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair p 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID 10181191 1 <br /> Test Date 1 1612025 <br /> Facility Name TULAREFARMS LLLP <br /> Facility Address City ZIP Code <br /> 2771 FRENCH CAMP ROAD FRENCH CAMP 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> t _ <br /> Company Performing the Test Phone <br /> ECO - CHEK 888-500-CHEK <br /> Mailing Address 3249 MT. DIABLO CT. LAFAYETTE , CA 94549 <br /> Service Technician Performing Test Zane NImmO <br /> Contractorl-rank Tester License Number04-1676 Ex. 4/30/2025 <br /> ICC Number ICC Expiration Date <br /> i 8883064-UT 5/27/2025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - EBW & Phil Tite #10009843708 12/7/2026 <br /> OPW #104-632 3/10/2026 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> LAKE TESTING SPILL BUCKET , DRAIN VALVE AND ADAPTER <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 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. 1 understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature I Date 1/6/2025 Total #of Pages <br /> 2 <br /> CERS = California Environmental Reporting System, ID = Identification, ICC = International Code <br /> Council <br /> Page 1 of 2 <br />