Laserfiche WebLink
Appendix VI EHD Received via CERS submittal: <br /> Underground Storage Tank 1/28/2023 <br /> Monitoring System Certification Form <br /> TYPE OF ACTION Ll installation LI Repair M 12 Month <br /> 1 FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 101816 57 01/19/2023 <br /> Facility Name <br /> CHEVRON#201383(N-2515-1-1) <br /> Facility Address City ZIP Code <br /> 1960 W.11TH STREET @ CORRAL HOLLOW TRACY 95376 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> Tanknology,Inc. 800-964-1250 <br /> Mailing Address <br /> 11000 N Mopac 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 ICC Expiration Date <br /> 9160945 05/03/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer-and Test Equipment Training Certifications Expiration Date <br /> Veeder Root:ATG Technician(C26533) 04/21/2023 <br /> Tanknology Certification:Level III LDT-5000 FTA Certification Exam(96737) 02/02/2025 <br /> 4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> 1 hereby certify that the monitoring system is operational in accordance with California Code <br /> of Regulations, tirle 23, division 3, chaprer 16, sec rion 2638; that required supporring <br /> documentation is attached; and aR information contained herein is accurate. <br /> Service Technician Signature Date Total # of Pages <br /> 01/19/2023 6 <br /> CERS, = California Environmental Reporting System: GPH = Gallons Per Hour, ID = Identification, <br /> ICC = International Cade Council. LLD = Line Leak Detector, NA = Not Applicable, SIN = Single- <br /> Walled, UDC = Under-Dispenser Containment. UST = Underground Storage Tank, <br /> VPH = Vacuum/Pressure/Hydrostatic <br /> Page 1 of 6 <br />