COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT FORM ( Page 1 of 6) Type of Action ❑ Installation Test ❑ Repair Test ❑ Six Month Test N 36 Month Test I . FACILITY INFORMATION CERS ID Date of Secondary Containment Test 10181913 07/08/2020 Business Name (Same as Facility Name or DBA-Doing Business As) Shell Business Site Address FL ity ZIP Code 16500 S . Harladn Road athro , CA 195330 II . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Phone # Marco Alejos (888) 500 - 2435 Ext, 2 Contractor/Tank Tester License # ICC Certification # ICC Certification Expiration Date 958763 8415074 04/27/2021 III . SUMMARY OF SECONDARY CONTAINMENT TESTING RESULTS Tank ID : (By tank number, stored product, etc.) A 87 B 91 Tank Containment Tightness Test Result N Pass ❑ Fail ❑ NA N Pass ❑ Fail ❑ NA Product Piping Containment Tightness Test Result ❑ Pass N Fail ❑ NA ❑ Pass N Fail ❑ NA Communication Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Remote Fill Piping Containment Tightness Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Communication Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Vent Piping Containment Tightness Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Communication Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Vapor Recovery Piping Containment Tightness Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Communication Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Turbine / Product Piping Sump Tightness Test Result N Pass ❑ Fail ❑ NA N Pass ❑ Fail ❑ NA Fill Riser Sump Tightness Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA Vent / Transition Sump ID: a b C d Tightness Test Result ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA UDC ID : 1 1 - 2 2 3-4 3 5-6 4 7- 8 Tightness Test Result N Pass ❑ Fail ❑ NA N Pass ❑ Fail ❑ NA N Pass ❑ Fail ❑ NA ❑ Pass N Fail ❑ NA UDC ID : 5 6 7 8 Tightness Test Result ❑ Pass ❑ Fail JNNA El Pass El Fail N NA ❑ Pass El Fail N NA E] Pass E] Fail N NA UDC ID : 9 10 11 12 Tightness Test Result F71 Pass El Fail ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA ❑ Pass ❑ Fail N NA All items marked "Fail' or "N/A " 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 information contained herein is accurate . UST Service Technician Signature 14"1 , 1 CERS = California Environmental Rel cation, UST = Underground storage tank, ICC = International Code Council, NA = Not applicable, UDC = Under-dispenser containment