California Code of Regulations
Title 23 - Waters
Division 3 - State Water Resources Control Board and Regional Water Quality Control Boards
Chapter 16 - Underground Tank Regulations
Appendix VIII - Underground Storage Tank Spill Container Testing Report Form

Universal Citation: 23 CA Code of Regs VIII
Current through Register 2024 Notice Reg. No. 52, December 27, 2024

TYPE OF ACTION [] Installation [] Repair []12 Month

1. FACILITY INFORMATION

CERS IDTest Date
___________________________
Facility Name
___________________________
Facility AddressCityZIP Code
___________________________

2. SERVICE TECHNICIAN INFORMATION

Company Performing the TestPhone
___________________________
Mailing Address
___________________________
Service Technician Performing Test
___________________________
Contractor/Tank Tester License Number
___________________________
ICC NumberICC Expiration Date
___________________________

3. TRAINING AND CERTIFICATIONS

Manufacturer and Test Equipment Training CertificationsExpiration Date
___________________________
___________________________
___________________________
___________________________

4. TEST PROCEDURE INFORMATION

Test Procedures UsedComponents Tested
___________________________
___________________________
___________________________
___________________________

5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST

I hereby certify that each spill container was tested in accordance with California Code of Regulations, title 23, division 3, chapter 16, section 2637.1; that required supporting documentation is attached; and all information contained herein is accurate. I understand that test procedures shall be made available upon request by the governing authority.

Service Technician SignatureDateTotal # of Pages
___________________________

CERS = California Environmental Reporting System, ID = Identification, ICC = International Code Council

6. SPILL CONTAINER DETAILS

Test Method Developed by [] Manufacturer [] Industry Standard [] Professional Engineer
Test Type [] Pressure [] Vacuum [] Hydrostatic
Tank ID
Spill Container Manufacturer:
Method of Cathodic Protection [] Nonmetallic [] Nonmetallic [] Nonmetallic [] Nonmetallic
[] Other [] Other [] Other [] Other
Is the spill container minimum capacity five gallons excluding riser volume [] Yes [] Yes [] Yes [] Yes
[] No* [] No* [] No* [] No*
Method to keep spill container empty [] Drain [] Drain [] Drain [] Drain
[] Pump [] Pump [] Pump [] Pump
[] Other [] Other [] Other [] Other
Spill Container Test Results [] Pass [] Pass [] Pass [] Pass
[] Fail [] Fail [] Fail [] Fail
Tank ID
Spill Container Manufacturer:
Method of Cathodic Protection [] Nonmetallic [] Nonmetallic [] Nonmetallic [] Nonmetallic
[] Other [] Other [] Other [] Other
Is the spill container minimum capacity five gallons excluding riser volume [] Yes [] Yes [] Yes [] Yes
[] No* [] No* [] No* [] No*
Method to keep spill container empty [] Drain [] Drain [] Drain [] Drain
[] Pump [] Pump [] Pump [] Pump
[] Other [] Other [] Other [] Other
Spill Container Test Results [] Pass [] Pass [] Pass [] Pass
[] Fail [] Fail [] Fail [] Fail

8. COMMENTS

Describe all answers marked "Other," "No," or "Fail" and each proposed remedy.

* Mark here if:

[] Spill containers do not have a minimum capacity of five gallons and require replacement.

Additional copies of this page may be attached.

1. New Appendix VIII filed 8-27-2018; operative 10-1-2018 (Register 2018, No. 35).
2. Repealer and new appendix filed 8-27-2020; operative 10-1-2020 (Register 2020, No. 35). Filing deadline specified in Government Code section 11349.3(a) extended 60 days pursuant to Executive Order N-40-20 and an additional 60 days pursuant to Executive Order N-66-20.

Disclaimer: These regulations may not be the most recent version. California may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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