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Appendix 8 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑✓ Repair ❑ 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10156811 01/16/2026 <br /> Facility Name <br /> Safeway 2707 <br /> Facility Address City ZIP Code <br /> 6425 N Pacific Ave Stockton 95207 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Able Maintenance, Inc. (707)545-5522 <br /> Mailing Address <br /> 3224 Regional Parkway, Santa Rosa, CA 95403 <br /> Service Technician Performing Testing <br /> David Delgado <br /> Contractor License Number <br /> 312844 <br /> ICC Certification ICC Expiration Date <br /> 5246959 10/08/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> INCON TS-STS LVL 4-0075823718 01/28/2028 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Hydrostatic Sump, UDC's <br /> Pressure Secondary piping <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 2666; that required supporting <br /> documentation is attached, and all information contained herein is accurate. I understand <br /> that test procedures must be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> 43yJ 01/16/2026 5 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment <br /> Page 1 of 4 <br />