Laserfiche WebLink
RECEIVED BY EHD <br /> 7/18/2022 - during inspection Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION Ll Installation _i Repair 19 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> CERS 10689070 07/06/2021 <br /> Facility Name <br /> Fed Ex Ground <br /> Facility Address Gity ZIP Code <br /> 120 S Hansen Road Tracy 95304 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailin�q Address <br /> 11000 N opac Expy#500 Austin,Tx 78759 <br /> Service Technician Performing Test <br /> Clint Fuhrman <br /> Contractor/Tank Tester License Number <br /> Class A General Engineering 743160 <br /> ICC Number IGC Expiration Date <br /> 9160945 05/03/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Lute <br /> Veeder Root:ATG Technician 04/21/2023 <br /> Tanknology Certification:Level III ATG Operability Training Certification Exam 02/04/2022 <br /> Tanknology Certification:Level III LDT-5000 FTA Certification Exam 02/04/2022 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that the monitoring system is operational in accordance with California Coate <br /> of Regulations, title 23, division 3, chapter 16,section 2636; that required supporting <br /> documentation is attached;and all information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 07/06/2021 6 <br /> CERS = California Environmental Reporting System, GPH = Gallons Per Hour, ID = Identification, <br /> ICC = International Code Council, LLD = Line Leak Detector, NA= Not Applicable, SW= Single- <br /> Walled, UDC = Under-Dispenser Containment, UST= Underground Storage Tank, <br /> VPH =Vacuum/Pressure/Hydrostatic <br /> Page 1 of 6 <br />