Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT <br /> Type of Action: ❑ Installation Test ® Repair Test ❑ 36 Month Test_ <br /> I. FACILITY INFORMATION <br /> CERS ID Date of Test: 8/28/2020 <br /> Business Name: Chevron <br /> Site Address: City Zip Code <br /> 444 Mossdale Road Lathrop _ <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Technician: Phone#: <br /> Rhome Desbiens 916-693-0555 <br /> Contractor License#: ICC Certification ID: ICC Expiration Date: <br /> 433159 1 5244364 1/4/2021 <br /> III. SUMMARY OF SECONDARY TESTING RESULTS <br /> TANK ID: A 87 B DSL i C D <br /> Tank Containment(Annular) <br /> Tightness Test Results ❑Pass❑Fail❑NA I El El ❑NA ❑❑Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> Product Piping Containment(Sec Line) <br /> Tightness Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Pass❑Fail❑NA <br /> Communication Test Results Pass Q Fail NA Q Pass Fail 0 Pass 11 FailNA ❑Pass❑Fail❑NA <br /> Remote Fill Piping Containment <br /> Tightness Test Results ❑Pass❑Fal E] NA ❑Pass El Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail _]NA <br /> Communication Test Results ❑Pass Fail❑NA ❑Pass❑Fail NA Pass❑Fail❑NA Q Pass Fail Q NA { <br /> Vent Piping Containment <br /> Tightness Test Results 11 Pass r-1 Fail E]NA ❑Pass❑Fail❑NA E]Pass E]Fail❑NA =Pass❑Fail El NA <br /> Communication Test Results Pass Lj Fail❑NA ❑Pass❑Fail❑NA ❑Pass Q Fail❑NA Pass Fail❑NA <br /> Vapor Recovery Piping Containment(Sec) <br /> Tightness Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> Communication Test Results ❑Pass❑Fail❑ NA Pass Fail NA ❑Pass❑Fail❑NA El Pass❑Fail❑NA <br /> Turbine/Product Piping Sump(STP) <br /> Tightness Test Results ®Pass❑Fail❑NA ®Pass❑ Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> _Fill Riser Sump <br /> Tightness Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA El ❑Fail❑NA ❑Pass E]Fail❑NA <br /> VENT/TRANSITION SUMP ID: a b c d <br /> Tightness Test Results ❑Pass Fail NA Pass Fail NA Pass Fail NA Pass Fail Q NA <br /> UDC ID: 1 2 11 3 4 <br /> Tightness Test Results Pass Fail NA El Pass Fail❑NA ❑Pass❑Fail NA ❑Pass❑Fail NA <br /> UDC ID: 5 6 7 8 <br /> Tightness Test Results Q Pass Fail NA Pass Fail❑NAI Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> UDC ID: 9 10 11 12 <br /> — — - - - _ –. <br /> Tightness Test Results Pass Fail NA Pass Fail NA Pass Fall NA Pass Fall NA <br /> All Items marked"Fail"or"NA"must be explained in their respective"Comments section <br /> IV. CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING <br /> I hearby certify that the secondary containment was tested in accordance with California Code of Regulations,Title 23,Division 3,Section <br /> 2637 and all the information contained herein is accurate --.-. <br /> UST Service Technician Signature <br />