Laserfiche WebLink
Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Form <br />TYPE OF ACTION ❑ Installation 0 Repair ❑ 6 Month ❑ 36 Month <br />1. FACILITY INFORMATION <br />CERS ID Test Date <br />10181485 3/17/2023 <br />Facility Name <br />YRC Freight #813 <br />Facility Address City ZIP Code <br />1535 E Pescadero Ave Tracy 95304 <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Nwestco LLC <br />Phone <br />(800) 339-9930 <br />Mailing Address <br />2209 Zeus Court, Bakersfield, CA 93308 <br />Service Technician Performing Test <br />Billy Lane <br />Contractor/Tank Tester License Number <br />1073967 <br />ICC Number <br />10281488 <br />ICC Expiration Date <br />3. TRAINING AND CERTIFICATIONS <br />Manufacturer and Test Equipment Training Certifications <br />Expiration Date <br />INCON Level 2 1022163714 <br />11/08/2024 <br />4. TEST PROCEDURE INFORMATION <br />Test Procedures Used <br />Components Tested <br />Incon <br />Sumps and UDC's <br />Precision mechanical test gauge <br />Tank annular's and line secondaries <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I 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 />A3�* x,7 <br />Date <br />3/17/2023 <br />Total # of Pages <br />3 <br />CERS = California Environmental Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispenser Containment, <br />Page 1 of 3 <br />