Laserfiche WebLink
Secondary Containment Testing Report For <br />F LR <br />For Use by Unidocs Member Agencies or where approved by your Local Jurisdiction <br />Authority Cited: Health and Safety Code §25293; Title 23 CCR §2637(a)(4) <br />This form, or the standard form develped by the State Water Resources Control Board (SWRCB), must be used <br />by contractors performing periodic testing of underground storage tank (UST) secondary containment systems <br />in Unidocs member agency jurisdictions. The completed form, 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 />SWRCB requires that the entire volume of each sump and under -dispenser containment (UDC) 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. [see SWRCB Local Guidance Letter Lc -160] <br />Systems where leak 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(a)(6)] <br />In the case of pressure/vacuum testing, aM 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. [23 CCR §2637(a)(2)] <br />A. Facility Information <br />Facility Name: <br />Valley Pacific Petroleum Services <br />Date of Testing: January 10, 2012 <br />Site Address: <br />1501 Charter Way, Stockton, CA <br />Facility Contact: <br />Mike Eliason Phone: 800-266-3782 <br />Date Local Agency <br />was Notified of Testing: 1-3-12 <br />Name of Local Agency Inspector (rfpresent during testing): <br />B. Testing Contractor Information <br />Company Name: Kern County Construction, Inc. <br />Credentials: ® CSLB-Licensed Contractor; ❑ SWRCB-Licensed Tank Tester <br />License Type: ® A; ❑ C-10; ❑ C-34; ❑ C-36; ❑ C-61 (D40) License Number: 481053 <br />Name of Technician Conducting Tests: Josh Simmons <br />Training by Equipment Manufacturer <br />Manufacturer Component(s) <br />Date Training Expires <br />Incon TS -STS <br />12-2-12 <br />C. Certification by Technician Responsible for Conducting Testing <br />To the best of my knowledge, the facts stated in this document are accurate and in full compliance with <br />legal requirements. <br />Technician's Signature: Date: & 17--/ z <br />UN -054 - 1/5 www.unidocs.org 02/26/02 <br />