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Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 35 Month <br /> I FACILITY 1NFORMATION <br /> CERS ID Test Date <br /> 10181657 01/24/2026 <br /> Facility Name <br /> Chevron 201383 <br /> Facility Address City zip Code <br /> 1960 West 11t" Street Tracy 01/24/2026 <br /> SERVICE TECHNICIAN, INFORMATfOIV <br /> Company Performing the Test Phone <br /> Wayne Per Inc. 714-826-0362 <br /> Mailing Address <br /> 8281 Commonwealth Avenue Buena Park CA 90621 <br /> Service Technician Performing Test <br /> Leonardo Martinez <br /> Contractor/Tank Tester License Number <br /> 300346 A B C611D40 HAZ <br /> ICC Number ICC Expiration Date <br /> 8360115 02/21/2026 <br /> 3 TRAIfING AND CERTIFICATlO.N.S <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> INCON Level 05/31/2026 <br /> 4 TEST PROCEDURE.INFORMAT!ON <br /> Test Procedures Used Components Tested <br /> PEI RP1200 Annulars <br /> PEI RP1200 Secondary Lines <br /> PEI RP1200 UDC°s <br /> PEI RP1200 Sumps <br /> ;;Ii CERTIFICATION BY6ERVICE TECHNICIAN CQNDlJCTING TEST <br /> I 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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature `!i' Date Total # of Pages <br /> 99 01/24/2026 <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 />