Laserfiche WebLink
SWRCB, January 2005 <br />This form is intended for use by contractors performing annual testing of UST spill containment structures. The completed form and <br />printouts from tests (if applicable), should be provided to the facility ownerloperator for submittal to the local regulatory agency. <br />*� s <br />Facility Name: ShellfTesoro Date of Testing: 1/28/14 <br />Facility address: 35 N. Cherokee Ln. Lodi, CA 95240 <br />Facility contact: Grace Keller (209) 369-1525 <br />Date Local Agency Was Notified of Testing: 12/27/13 <br />Name of Local Agency Inspector (if present during testing). Aries <br />pffi�* * *. *; <br />Company Name: Service Station Systems <br />Technician Conducting Test: Kris Bell <br />Credentialst: ® CSLB contractor ® [CC Service Tech. [] SWRCB Tank Tester Q Other (Specify) <br />License Number(s): License: 485184 ICC:5297793-UT <br />Comments:- Diesel Fill Drain & Fill Cap r & Passed. <br />CERTIFICATION OF TECHNICIAN RESPONSIBLE FOR CONDUCTING THIS TESTING <br />I hereby certify that all the information contained In this report Is true, accurate,and In full compliance with legal requirements. <br />Technician's Signature: Date: 1/28/14 <br />I State laws and regulations do not currently require testing to be performed by a qualified contractor. However, local requirements <br />may be more stringent. <br />