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COMPLIANCE INFO_2020
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2300 - Underground Storage Tank Program
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PR0231289
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COMPLIANCE INFO_2020
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Last modified
1/7/2021 11:34:44 AM
Creation date
8/11/2020 10:18:39 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0231289
PE
2361
FACILITY_ID
FA0003847
FACILITY_NAME
WEST LANE FUEL
STREET_NUMBER
3300
Direction
N
STREET_NAME
WEST
STREET_TYPE
LN
City
STOCKTON
Zip
95204
APN
11705037
CURRENT_STATUS
01
SITE_LOCATION
3300 N WEST LN
P_LOCATION
99
P_DISTRICT
002
QC Status
Approved
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SJGOV\kblackwell
Tags
EHD - Public
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Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month ® 36 Month <br />1. FACILITY INFORMATION <br />CERS ID Test Date <br />10181477 12/9/2020 <br />Facility Name <br />West Lane Fuels <br />Facility Address City ZIP Code <br />3300 North West Lane Stockton 95204 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />R&D Compliance Testing <br />Phone <br />707 621-0378 <br />Mailing Address <br />P.O. Box 1503 Ukiah Ca. 95482 <br />Service Technician Performing Test <br />Ben'amin Duncan <br />Contractor/Tank Tester License Number <br />Tank Tester License #90-1120 <br />ICC Number <br />5246802 -UT <br />ICC Expiration Date <br />3/21/2021 <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />Caldwell Systems Level Change Indicator <br />6/10/2023 <br />ICC Service Technician #5246802 -UT <br />3/21/2021 <br />Underground Storage Tank Tester License #90-1120 <br />12/31/2022 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Vacuum <br />Tank Secondary Containment <br />Pressure <br />Product Piping Secondary Containment <br />Hydrostatic <br />Piping Sumps/UDC's <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />1 hereby certify that the secondary containment was tested in accordance with California <br />Code of Regulations, title 23, division 3, chapter 16, section 2637; that required supporting <br />documentation is attached; and all information contained herein is accurate. I understand <br />that test procedures shall be made available upon request by the governing authority. <br />Service Technician Signature <br />Date <br />12/9/2020 <br />Total # of Pages <br />5 <br />V <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, <br />Page 1 of 5 <br />
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