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Appendix VII <br /> Underground Storage Tank SR# 2400414 <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation 0 Repair ❑ 6 Month ❑ 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10184725 11/21/24 <br /> Facility Name <br /> West Valley Auto Service <br /> Facility Address City ZIP Code <br /> 2615 W. Grantline Rd Tracy 95204 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Elite IV Contractors (209) 461-6337 <br /> Mailing Address <br /> 2535 Wigwam Dr Stockton, Ca 95205 <br /> Service Technician f'eefijfMNal%ina <br /> Contractor/Tank Tester License Number A <br /> ICC Number ICC Expiration Date <br /> 9519380 6/4/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Diversified Products Manufacturing 7/25/27 <br /> Fiberglass Systems NOV 2/7/27 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Pressure Air Gauge 87 Vent Pipe Test Boot <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. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Servi Technician Signature at Total # of Pages <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 />