Laserfiche WebLink
□ Installation □ Repair ®i 12 MonthTYPE OF ACTION <br />1. FACILITY INFORMATION <br />2. SERVICE TECHNICIAN INFORMATION <br />3. TRAINING AND CERTIFICATIONS <br />VMI:TLDT-5000 Tester (3802)11/07/2025 <br />OPW:EVR Phase 1 (104302)01/04/2025 <br />ICC:CA UST Service Technician (8361393)05/16/2025 <br />Date <br />02/07/2024 <br />Page 1 of 6 <br />GERS = 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 />ICC Number <br />8361393 <br />Facility Name <br />CHEVRON #208117 <br />Phone <br />800-964-1250 <br />Certification Date <br />02/07/2024 <br />Total # of Pages <br />6 <br />Facility Address <br />755 S. TRACY BLVD <br />Company Performing the Certification <br />Tanknology, Inc. <br />Service Technician Performing Test <br />Jesus Saldivar <br />Contractor/Tank Tester License Number <br />Class A General Engineering 743160 <br />Mailing Address <br />11000 N Mopac Expy #500 Austin, Tx 78759 <br />CERS ID <br />10182313 <br />Appendix VI <br />Underground Storage Tank <br />Monitoring System Certification Form <br />City <br />TRACY <br />ICC Expiration Date <br />05/16/2025 <br />ZIP Code <br />95376 <br />Manufacturer and Test Equipment Training Certifications <br />Veeder RootATG Technician (B45334) <br />Expiration Date <br />04/03/2025 <br />4. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />I hereby certify that the monitoring system is operational in accordance with California Code <br />of Regulations, title 23, division 3, chapter 16, section 2638; that required supporting <br />documentation is attached; and all information contained herein is accurate. <br />Service Technician Signature