Laserfiche WebLink
Appendix VI <br /> Underground Storage Tank <br /> Monitoring System Certification Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 12 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Certification Date <br /> 10184725 03-07-2025 <br /> Facility Name <br /> WEST VALLEY AUTO SERVICE CHEVRON <br /> Facility Address City ZIP Code <br /> 2615 GRANTLINE ROAD TRACY 95304 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Certification Phone <br /> ECO CHEK COMPLIANCE, INC. 1-888-500-2435 <br /> Mailing Address <br /> P.O. BOX 1394 LAFAYETTE, CA 94549 <br /> Service Technician Performing Test <br /> Felix Ramirez <br /> Contractor/Tank Tester License Number <br /> 08-1740 5/31/2026 <br /> ICC Number ICC Expiration Date <br /> 8883072-UT 11/11/2026 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Franklin Fueling - EBW & Phil Tite #1009883708 12/28/2026 <br /> OPW #104634 3/10/2026 <br /> CNI #5001 02/07/2025 <br /> PNUEMERCATOR 10715 05/17/2025 <br /> SB BRAVO 2021-2929022 01/26/2026 <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, 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 Date Total # of Pages <br /> 03-07-2025 2 <br /> CERS = 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 /> Page 1 of 6 <br />