Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT <br /> Type of Action: ❑ Installation Test ® Repair Test _ ❑ 36 Month Test <br /> I. _ <br /> -------FACILITY INFORMATION _ <br /> CERS ID Date of Test 8/31/2020 <br /> Business Name: Chevron <br /> Site Address: City Zip Code <br /> 444 Mossdale Road Lathrop <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Technician: Phone If: <br /> Rhome Desbiens 916-693-0555 <br /> Contractor License#: ICC Certification ID: ICC Expiration Date: <br /> 433159 5244364 1/4/2021 <br /> III. SUMMARY OF SECONDARY TESTING RESULTS <br /> TANK ID: A All B _F -- -- C D <br /> Tank Containment(Annular) <br /> Tightness Test Results I ®Pass[0]Fail❑NA El Pass[-]Fail E]NA [I Pass El Fail Q NA ❑Pass❑Fail❑NA <br /> _Product Piping Containment(Sec Line) <br /> Tightness Test Results ❑Pass El Pail❑NA El Pass E]Fail E]NA [I ass El Fail El NA ❑Pass❑Fail❑NA <br /> Pass Fail ❑ <br /> NA Pass Fail❑NA Pass❑Fail NA Q Pass Fai <br /> Communication Test Results ❑ l❑NA <br /> Remote Fill Piping Containment <br /> Tightness Test Results Q Pass❑Fail❑NA pass-❑Fall❑NA ❑Pass❑Fail❑NA Q Pass❑Fail❑NA <br /> Communication Test Results Pass Fail❑NA El Pass El Fail❑NA ❑Pass❑Fail❑NA ~❑Pass Fail NA i <br /> I <br /> Vent Piping Containment <br /> Tightness Test Results ❑Pass❑Fail Q NA ❑Pass E]Fail[INA ❑Pass❑Fail❑NA Pass Fail❑NA <br /> Communication Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Pass Fail NA Pass Fail NA <br /> Vapor Recovery Piping Containment(sec) <br /> Tightness Test Results LJPass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> Communication Test Results ❑Pass❑ <br /> Fail NA ❑ Pass Fail❑NA ❑Pass Fail❑NA Q Pa55❑Fail❑NA <br /> Turbine/Product Piping Sump(STP) <br /> Tightness Test Results E]Pass❑Fail❑NA ❑Pass E]Fail E]NA Q Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> Fill Riser Sump —I <br /> Tightness Test Results E]Pass❑Fail C]NA ❑Pass❑Fail❑NA E]Pass❑Fail❑NA ❑pass❑Fail❑NA <br /> VENT/TRANSITION SUMP ID: a b c d <br /> Tightness Test Results ❑Pass Fail NA Pass Fail NA ❑Pass❑Fail NA ❑Pass❑Fail NA <br /> UDC ID: 1 2 3 4 <br /> Tightness Test Results ❑Pass Lj Fail NA CC3 Pass Fail NA ❑Pass❑Fail NA Pass 0 Fail 0 NA <br /> UDC ID: 5 6 � $ <br /> Tightness Test Results Pass Fail NA Pass Fail NA ❑Pass❑Fail❑NA Pass Fail NA <br /> UDC ID: _ 9 10 it 12 <br /> Tightness Test Results Q Pass Fail NA PASS Frill NA PO]! Fall NA Pass Fail NA <br /> All items marked"Foil'or"NA"must be explained in their respective"Comments section <br /> IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> I hearby certify that the secondary containment was tested in accordance with California Code of Regulations,Title 23,Division 3,Section <br /> 2637 and all the information contained herein is accurate — <br /> UST Service Technician Signature '/� <br />