COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

UNDERG U STOR. GE4T�NK � ��" SECONDARY CO11 ' E NTAINM STIE (S RE0 � T Ft ( Page 1 of s) Type of Action ❑ Installation Test ❑ Repair Test ❑ Six Month Test Z 36 Month Test I . FACILITY ItV ORMr 1 N` CERS ID Date of Secondary Containment Test 10181253 , s NVI 3 t� li I - - " � .qj t, 3/ 17/2020 Business Name Same as Facility Name or DBA-Doing Business AS Benjamin Holt Arco ° Business Site Address City ZIP Code 2908 Benjamin Holt Drive Stockton 95207 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification) Phone # Benjamin Duncan ( 707 ) 621 -0378 Contractor / Tank Tester License # ICC Certification # ICC Certification Expiration Date Tank Tester License #90 - 1120 5246802- UT 3/21 /2021 III . SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS TANK ID : (By tank number, stored product, etc.) A TARegular 87 B T-2- Regular 87 C T-3- Super 91 D Condensed Vapor Piping Tank Containment Tightness Test Result O Pass ❑ Fail ❑ NA E Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail O NA Product Piping Containment Tightness Test Result E Pass ❑ Fail ❑ NA E Pass ElFail ElNA O Pass ❑ Fail ❑ NA E Pass ❑ Fail ❑ NA Communication Test Result O Pass ❑ Fail ❑ NA O Pass ❑ Fail ❑ NA E Pass ❑ Fail ❑ NA E Pass ❑ Fail ❑ NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail ENA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail O NA Communication Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA Vent Piping Containment Tightness Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA Communication Test Result ❑ Pass ❑ Fail El NA [IPass E] Fail E NA ❑ Pass ❑ Fail E NA El Pass ❑ Fail ENA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA Communication Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA Turbine / Product Piping Sump Tightness Test Result E Pass El Fail ❑ NA E Pass El Fail E] NA E Pass El Fail ❑ NA ❑ Pass ❑ Fail ENA Fill Riser Sump Tightness Test Result ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA ❑ Pass ❑ Fail E NA VENT / TRANSITION SUMP ID : a Vapor Pot Sump b C d Tightness Test Result E Pass ❑ Fail ❑ NA E Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail E NA UDC ID : 1 1 &2 2 3&4 3 5&6 4 7&8 Tightness Test Result E Pass ❑ Fail ElNA E Pass ❑ Fail ❑ NA E Pass ElFail ❑ NA E Pass ElFail ElNA UDC ll) : 5 6 7 $ Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA UDC ID : 9 10 11 12 Tightness Test Result ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA ❑ Pass ❑ Fail ❑ NA All items marked "Fail" or "NA " must be explained in their respective "COMMENTS " section. IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the secondary containment was tested in accordance with California Code of Regulations , Title 23 , Division 3 , Chapter 16 , Section 2637 and all the informationcontainedherein is accurate . UST Service Technician Signature CERS = Califomia Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = Intemational Code Council, NA = Not Applicable, UDC = Under- Dispenser Containment