Laserfiche WebLink
Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑Installation ❑Repair 06 Month x36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10182265 10/16/2023 <br /> Facility Name <br /> ARCO AM PM #82602 <br /> Facility Address City ZIP Code <br /> 2430 Joe Pombo Pkwy Tracy 95376 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Diamond Petroleum Services, Inc. (925)470-0803 <br /> Mailing Address <br /> 3619 King Ct Antioch, CA 94509 <br /> Service Technician Performing Test <br /> Guadalupe Sanchez <br /> F100(01 <br /> tractor/Tank Tester License Number <br /> 5444 <br /> ICC Number ICC Expiration Date <br /> 5250451 04/0112025 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> NOV FIBER GLASS SYSTEMS 05/06/2025 <br /> CALDWELL SYSTEMS 0612025 <br /> ZCLIXERXES 11/18/2024 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Pressure Test Secondary Lines <br /> Vacuum Test Annular Tanks <br /> Hydrostatic Test UDCs and Sumps <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the secondary containment was tested in accordance with California Code of <br /> Regulations, title 23, division 3, chapter 96, section 2637, that required supporting documentation is <br /> attached;and all information contained herein is accurate. I understand that test procedures shall be <br /> made available upon request by the governing authority. <br /> Service Technician Signature Date Total #of Pages <br /> 10/16/2023 5 <br /> 6. TANK SECONDARY CONTAINMEN EST <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 />