Laserfiche WebLink
UNDERGROUND STORAGE TANK <br /> SECONDARY CONTAINMENT TESTING REPORT <br /> Type of Action: ❑ Installation Test ❑ Repair Test ® 36 Month Test <br /> 1. FACILITY INFORMATION <br /> CERS ID Date of Test: 3/27/2019 <br /> Business Name: Chevron-Lathrop <br /> Site Address: City Zip Code <br /> 444 Mossdale Lathrop <br /> II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION <br /> Name of UST Technician: Phone#: <br /> Vic Arneson 916-693-0555 <br /> Contractor License#: ICC Certification ID: ICC Expiration Date: <br /> 433159 8709495 12/27/2021 <br /> III. SUMMARY OF SECONDARY TESTING RESULTS <br /> TANK ID: A 87 8 91 C DSL D <br /> Tank Containment(Annular) <br /> Tightness Test Results ®Pass❑Fail❑NA ®Pass❑Fail❑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❑Fail❑NA ®Pass❑Fail❑NA ®Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> Remote Fill Piping Containment <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 ❑Pass❑Fail❑NA <br /> Vent Piping Containment <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 ❑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 ❑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 ❑Pass❑Fail®NA E]Pass❑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❑NA <br /> UDC ID: 1 1/2 2 3/4 3 5/6 4 7/8 <br /> Tightness Test Results ®Pass❑Fail❑NA ®Pass❑Fail❑NA ®Pass❑Fail❑NA ®Pass❑Fail❑NA <br /> UDC ID: 5 9/10 6 11/12 7 8 <br /> Tightness Test Results ®Pass❑Fail❑NA ®Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA <br /> UDC ID: 9 10 11 12 <br /> Tightness Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑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 Q **"on9,-TI,tte 23,pivisiorF7�,"9 <br /> 2637 and all the information contained herein is accurate <br /> UST Service Technician Signature <br /> APR 17 2019 <br /> ENVIRONMENTAL HEALTH <br /> DEPARTMENT <br />