Laserfiche WebLink
May. 9. 2017 4: 11PM Donlee Pump Co -0: 1237 Ps:� 2 <br /> E k P $ § r\ . <br /> Secondary Containment Testing Report Form;,,;,;,- <br /> For Use by Unidocs Member Agencies or-where approved by your Local Jurisdiction <br /> authority Cited.- Health and Safety Cade§25293;Title 23 CCR§ 07(a)(4) <br /> E :, m _TH <br /> This form, or the standard four develped by the State Water Resources Control Board(SWRCB), most be used <br /> by contractors performing periodic testing of underground storage tank (UST) secondary containment systems <br /> in Undoes member agency jurisdictions. The completed foam,written test procedures, data collection logs, and <br /> printouts from test equipment (if applicable), must be provided.to the facility owner/operator for submittal to <br /> the local regulatory agency within 30 days of the test date. <br /> S' RCB requires that the entire Volume of each sump and under-dispenser containment(LOC)system be tested <br /> if the sump/UDC is not equipped with a continuous monitoring system that shuts down the pump when a leak is <br /> detecetd or the leak detection sensor fails or is disconnected. [Sep 3WPCE1 rocas Guidance Letter l.0-160] <br /> Systems where leaf detection equipment continuously monitors both primary and secondary containment (e.g. <br /> systems that are hydrostatically monitored or under constant vacuum) are exempt from periodic testing <br /> requirements. [23 CCR§2637(x)(6)] <br /> In the case of pressure/vacuum testing, my loss in pressure/vacuum during the course of the test shall be <br /> considered a failed test,regardless of the manufacturer's criteria for declaring a passed test. p3 CCR.§2637(a)(2)] <br /> A. Facility Information <br /> Facility Name: Statewide Petroleum Date of Testing: May 9,20X7 <br /> Site Address: 1700 E. Yosemite Ave. Manteca,CA. <br /> Facility Contact: Sunny Thane: 4Q5-230-8999 <br /> Date]Local Agency was Notified of Testing: 512/2017 <br /> Name of focal Agency Inspector(fpresent during testing): <br /> B. Testing Contractor Information <br /> Company Name: Donlee Pump Company <br /> Credentials: ❑CSLB-(Licensed Contracwr; []SWRCB-Licensed Tank Tester <br /> License Type: E]A;Q C-10;[]C-34;❑C-36;❑C-61(D40) 777� License Number: B43182 <br /> Name of Technician Conducting Tests: Anthon Lelr'as <br /> Trainin b E ui ment Manu etuirer <br /> Manufacturer Component(s) Date Training Expires <br /> Franklin Fueling Incon Levl 4 7529843707 11/11117 <br /> C. Certification by Technician Responsible for Conducting Testing <br /> To the best of my knowledge,the facts st tell in this document are accurate and in full compliance with. <br /> legal requirements. <br /> Technician's Signature; Date: <br /> UST-051-115 vtnYmunidoes.org 02/7002 <br />