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Appendix 6 <br /> Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair 0 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181239 2/13/2026 <br /> Facility Name <br /> A & A GAS & FOOD MART <br /> Facility Address City ZIP Code <br /> 16 E. HARDING WAY STOCKTON 95204 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> ECO- CHEK Compliance Inc. 888-500-CHEK <br /> Mailing Address <br /> 3100 OAK ROAD , SUITE 205 -- WALNUT CREEK CA 94597 <br /> Service Technician Performing Testing <br /> Zane Nimmo <br /> Contractor License Number <br /> 04-1676 Ex. 4/30/2028 <br /> ICC Certification ICC Expiration Date <br /> 8883064-UT 5/28/2027 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training 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 /> I hereby certify that each spill containment was tested in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 16, section 2664; 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 re uest by the governing authority, <br /> Service Technician Signature Date Total # of Pages <br /> 2/13/2026 2 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification <br /> Page 1 of 2 <br />