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! 0 . <br /> Under 9 PPenclix VII <br /> oUnd Stora <br /> Secondary ContaitIment ge Tank <br /> ❑ Installation Testis <br /> 71�N <br /> p fe nr INFORMATION epair g Re <br /> Iulo Port F� <br /> 6 nth <br /> GILL <br /> _ 111 FA t0 ® Month <br /> e Test Date <br /> Fa IK SERV Lodi BVV113 2/6124 <br /> � <br /> 1 Faoility address <br /> W Kenlerr'man Lane City <br /> I QZ0. <br /> SERVICE TECHNICIAN INFORMATION Lodii ZIp <br /> Code <br /> Cori Performing the Test 95240 <br /> LC RVICES <br /> q in Address <br /> Phone <br /> 887 N VALENTINE 559-444_1730,� Qa <br /> 1' ( $eNice Technician Performing Test <br /> pedrew Shaffer <br /> Contractor/Tank Tester License Number ? <br /> � V <br /> l r19267 — - —-- — <br /> f ICC Number <br /> f 10032262 ICC Expiration Date <br /> 3 TRAINING AND CERTIFICATIONS — 09111/25 `Q <br /> -I Manufacturer and Test,Equipment Training Certifications <br /> V C31141 --- Expiration Date <br /> Sump System Operation: 1001213714 02/26 <br /> 01126 <br /> 4. TEST PROCEDURE INFORMATION <br /> 1' T=st Procedures Used Components 'Tested <br /> HYDROSTATIC SUMPS AND UDCS <br /> VACUUM ANNUALAR <br /> PRESSURE PRODUCT SECONDARY <br /> 5. CERTIFICATION I3Y SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the.secondary containment was tested in accordance with California <br /> Code of Regulations, titJ'e 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 Signati_ Date Total 11 of Pages <br /> CERS == California Environmental Reporting System ICC = International Code Council, <br /> ►IA _ ►1_l A,_,1'__LI_ I Ir'1!+ -. 11_.J.... 1:_...__•.- <br />