Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> SPILL CONTAINER TESTING REPORT FORM <br /> Type of Action ❑Instedaion Tea 0 Repair Test Q 12 Math Test <br /> I. FACILITY INFORMATION <br /> CERS ID Date of Spill Con finer Test <br /> 10181885 0110412019 <br /> Business Name(Same..Facl#fy Nameor DBA-Odrg Business As.) <br /> VALLEY PACIFIC LODI PLANT&CARDLOCK <br /> Business Site Address city aP Code <br /> 931 EVictor Ave. Lodi 95240 <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Service Technician Performing the Tea(PrlMas sho ion on the ICC Certification.) Phone# <br /> Garrett Warren 1 (916) 991 - 1100 <br /> ContrectarRarYr Tester License# ICC Certification# ICC Certificalion Expiration Date <br /> CSLB#803616 SWRB#06-1672 8185019 10-2-2019 <br /> Spill Chan.Testing Training and Cerfifications(List applicable certifications..) <br /> OPW EVR 101018 exp. 6-9-2019 <br /> III. SPILL CONTAINER TESTING INFORMATION <br /> Test Method 0 Manufacturer Guidelines: <br /> Used: (Specify) <br /> ®Industry Code or Engineering Standard: RIP 1200 <br /> (Specify) <br /> 0 Engineered Method: <br /> (Specify) <br /> Attach the testing Procedures and alldocumental requlrerlto datermine the results. #of Attached Pages <br /> Tank ID:(By tank number,starer/prorlmY,etc.) T6: 87 UNL T7: 87 UNL <br /> Spill Container Manufacturer: OPW OPW <br /> W Non-Metallic Non ketallic ❑NonWetallic ❑NonWetallic <br /> Method of Cathodic Protection Isolation Isolation ❑Isolation ❑Isolation <br /> ❑Other ❑Other ❑Other 0 Other <br /> (Speckly In section vJ (Scechy In zxnon v1 (SPec#y In section V) (Spec#y In sxtlon v) <br /> Inside Diameter of Spill Container:(Inches) <br /> Depth of Spill Container:(inches) 11 11 <br /> Does the spill container have a 5 gallon 0, Y. No 0' Yes 0 No 0 Yes 0 No ❑Yes 0 No <br /> aci 7 <br /> Q Drain Varve M Oran Valve ❑Man Valve 0 Drain Valve <br /> Method to Keep Spill Container Empty ❑Onsite Pump 0 Oreille Pump ❑Onsite Pump 0 Onsite Pump <br /> 0 Other 0 Other ❑Other 0 Other <br /> (Spec#y In section vJ (Spec#y In section v) (Speclly In section vJ iliSpecilyinsatfionlIj <br /> IV. SUMMARY OF TESTING RESULTS <br /> Spill Container Test Results O Pass 0 Fail 1 0 Pass R Fail 0 Pass 0 Fail ❑ Pass 0 Fal <br /> V. COMMENTS <br /> All items marked"Fa#"all must be explained in this section.Any additional co mnenfs may also be provided here. <br /> The T7: UNL bucket failed. it originally spun in the greuntl during the OPI inspection. Bucket vnll be replaced and tested at a later Jate. <br /> VI. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> 1 hereby certify Met the said containers were tested in accenleone wish Caifornia Code of RegJaiors,title 23,cMsion 3,chapter 16,section <br /> 2637.1 and al the infonnati on contained herein is accurate. <br /> UST Sent ce Technician Signature <br /> If Me fa Wfity has more pal#lpoent5 then the Monthaorormnotlats,ao'dltkma copies ofthls page may be attached. <br /> CERS=Caforria Envrarmer[al Reposing System ID=kkrEficatinm UST a UndeUound storagetsniq CC=international Cade Council <br />