Laserfiche WebLink
Appendix 8 <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TESTING TYPE ❑ Installation ❑ Repair x 36 Month <br /> 11. FACILITY INFORMATION <br /> CERS ID 1/6/2026 <br /> 10180661 <br /> Stop N Shop <br /> 1856 Country Club Blvd. Stockton 95204 <br /> 12. SERVICE TECHNICIAN INFORMATION <br /> Company Performing Testing: (707) 621-0378 <br /> Duncan Compliance: Dba, R&D Compliance Testing <br /> Mailing Address: <br /> P. O. Box 1503 Ukiah, CA 95482 <br /> Service Technician Performing Testing: <br /> Benjamin Duncan <br /> Contractor License Number: <br /> 1036490 <br /> ICC Certification: ICC Expiration Date: <br /> 5246802-UT 1/30/2027 <br /> 13. TRAINING AND CERTIFICATIONS I <br /> Manufacturer and Test Equipment Training Certifications Training Expiration Date <br /> Caldwell Level Change Indicator 6/23/28 <br /> PEI Certificate of Completion-PEI Service Technician 5/4/27-5/6/27 <br /> Franklin Fueling Systems-Pro Compliance Testing 5/23/27 <br /> XERXES Corporation-Modern Welding Company-Western Fiberglass, Inc. /5/274/12/27-5/3/27 <br /> 14. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Vacuum Tank Secondary Containment <br /> Pressure Piping Secondary Containment <br /> Hydrostatic Piping Sumps <br /> Hydrostatic Dispenser Sumps <br /> 15. 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 2666; that required supporting <br /> documentation is attached; and all information contained herein is accurate. I understand <br /> that test procedures must be made available upon request by the governing authority. <br /> Service Technician Signature 1/6/2026 Total # of pages <br /> ,1 _T 4 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment <br /> Page 1 of 4 <br />