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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10399867 <br /> Facility Name <br /> Hunt & Sons LLC <br /> Facility Address City ZIP Code <br /> 4733 S Hwy 99 Frontage Rd Stockton 95201 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Hunt Equipment DBA:Donlee Pump Company 209 537-9396 <br /> Mailing Address <br /> 2825 Railroad Ave. Ceres CA. 95307 <br /> Service Technician Performing Test <br /> Gerardo Perez <br /> Contractor/Tank Tester License Number <br /> 1018253 <br /> ICC Number ICC Expiration Date <br /> 10250519 3/3/25 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - Incon Level 4 1/4/26 <br /> OPW 2114/25 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Incon Level 4 Sumps, Piping, Annular Space <br /> PEI-1200 Sumps, Piping, Annular Space <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that the secondary containment was tested in accordance with California <br /> Code of Regulations, title 23, division 3, chapter 16, section 2637; 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 Technici Signature Date Total # of Pages <br /> -- zU <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 5 <br />