COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK SECONDARY CONTAINMENT TESTING REPORT Type of Action: ❑ Installation Test ❑ Repair Test ® 36 Month Test I. FACILITY INFORMATION CERS ID Date of Test: 11/29/2019 Business Name: George Kishida Site Address: City Zip Code 1725 Ackerman Dr Lodi II. UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Technician: Phone#: Vic Arneson 916-693-0555 Contractor License#: ICC Certification ID: ICC Expiration Date: 433159 87094955 12/27/2020 III. SUMMARY OF SECONDARY TESTING RESULTS TANK ID: A DSL-1 B DSL-2 C D Tank Containment(Annular) Tightness Test Results ®Pass❑Fail❑ NA ®Pass❑Fail❑NA ❑Pass❑ Fail❑ NA ❑ Pass❑Fail❑NA Product Piping Containment(Sec Line) Tightness Test Results ®Pass❑Fail❑NA ®Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Communication Test Results ® Pass❑Fail❑NA ®Pass❑ Fail❑NA ❑ Pass❑Fail❑NA ❑Pass❑Fail❑NA Remote Fill Piping Containment Tightness Test Results ❑Pass❑Fail®NA ❑Pass❑Fail®NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Communication Test Results ❑Pass❑Fail®NA ❑Pass❑Fail®NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Vent Piping Containment Tightness Test Results ❑Pass❑Fail®NA ❑Pass❑Fail®NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Communication Test Results ❑ Pass❑Fail®NA ❑Pass❑Fail®NA ❑Pass❑ Fail❑ NA ❑Pass❑Fail❑NA Vapor Recovery Piping Containment(Sec) Tightness Test Results ❑Pass❑Fail®NA ❑Pass❑ Fail®NA ❑ Pass❑Fail❑NA ❑Pass❑Fail❑NA Communication Test Results ❑Pass❑Fail®NA ❑Pass❑Fail®NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA Turbine/Product Piping Sump(STP) Tightness Test Results ®Pass❑ Fail❑NA ®Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑ Fail❑NA Fill Riser Sump Tightness Test Results ❑Pass❑Fail®NA ❑Pass❑Fail®NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA VENT/TRANSITION SUMP ID: a b c d Tightness Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA UDC ID: 1 1 2 2 3 1A 4 Tightness Test Results ®Pass❑Fail❑NA ®Pass❑Fail❑NA ®Pass❑Fail❑NA ❑Pass❑Fail❑NA UDC ID: 5 6 7 8 Tightness Test Results ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA ❑Pass❑Fail❑NA UDC ID: 9 10 11 12 Tightness Test Results ❑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 hearby certify that the secondary containment was tested in accordance with California Code of Regulations,Title 23,Division 3,Section 2637 and all the information contained herein is accurate UST Service Technician Signature '/ v( .