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Appendix 6 <br /> Underground Storage Tank <br /> Spill Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair ❑✓ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10180893 4/2/26 <br /> Facility Name <br /> Quik Stop Market 132 <br /> Facility Address City ZIP Code <br /> 3555 W Hammer Ln Stockton 95206 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing Phone <br /> Service Station Systems (408)971-2445 <br /> Mailing Address <br /> 680 Quinn Ave San Jose CA 95112 <br /> Service Technician Performing Testing <br /> Kristopher Bell <br /> Contractor License Number <br /> 485184 <br /> ICC Certification ICC Expiration Date <br /> 8833000 1/8/27 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Franklin Fueling# 1004933708 6/11126 <br /> OPW# 1192275 4/28/27 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> OPW SPILL BUCKETS <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 request by the governing authority, <br /> Service Technician Signature 'f <br /> Date Total # of Pages <br /> 4/2/26 3 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification <br /> Page 1 of 2 <br />