COMPLIANCE INFO_2020 - Laserfiche WebLink

Home Browse Search

UNDERGROUND STORAGE TANK SPILL CONTAINER TESTING REPORT FORM (Page 1 of 1 ) Type of Action ❑ Installation Test ❑ Repair Test ❑x 12 Month Test 1 . FACILITY INFORMATION CERS ID Date of Spill Container Test 10181461 6/ 12/20 Business Name (Same as Facility Name or DBA-Doing Business As) VANCO TRUCK STOP Business Site Address City ZIP Code 1033 W CHARTER WAY STOCKTON , CA 95205 11 . UNDERGROUND STORAGE TANK SERVICE TECHNICIAN INFORMATION Name of UST Service Technician Performing the Test (Print as shown on the ICC Certification.) Phone # EDWARD STEARNS 1 ( 209 ) 744 -0112 Contractor I Tank Tester License # ICC Certification # ICC Certification Expiration Date 14- 1760 Ex . 9/30/20 888308MT 11 /9/2020 Spill Container Testing Training and Certifications (List applicable certifications.) 111 . SPILL CONTAINER TESTING INFORMATION Test Method Used : ❑x Manufacturer Guidelines (Specify) : LAKE TEST ❑ Industry Code or Engineering Standard (Specify) : ❑ Engineered Method (Specify) : Attach the testing procedures and all documentation required to determine the results. # of Attached Pages TANK ID : (By tank number, stored product, etc.) 87 1(specifyin DIESEL DIESEL EAST Spill Container Manufacturer: PHIL TITE PHPHIL TITS PHIL TITE Method of Cathodic Protection : ❑x Non-Metallic N Non- Z Non-Metallic 0 Non-Metallic ❑ Isolation ❑ Isola ❑ Isolation ❑ Isolation ❑ Other (Specify in V.) ❑ Othe ❑ Other (Specify in V.) ❑ Other (Specifyin V.)Inside Diameter of Spill Container: (Inches)Depth of Spill Container: (Inches) 13 13 13 Does the spill container have a 5 gallon capacity? ❑x Yes ❑ No I] Yes ❑ No 0 Yes ❑ No 0 Yes ❑ No Method to Keep Spill Container Empty: ❑x Drain Valve ❑ Drain Valve ❑ Drain Valve ❑ Drain Valve ❑ Onsite Pump ❑ Onsite Pump ❑ Onsite Pump ❑ Onsite Pump ❑ Other (Specify in V.) ❑ Other (Specify in V.) ❑ Other (Specify in V.) ❑ Other (Specify in V.) IV. SUMMARY OF TESTING RESULTS Spill Container Test Results : ❑D Pass ❑ Fail ❑x Pass ❑ Fail ❑x Pass ❑ Fail (] Pass ❑ Fail V. COMMENTS Any items marked "Fail" above must be explained in this section. Any additional comments may also be provided here . VI . CERTIFICATION BY UST SERVICE TECHNICIAN CONDUCTING THIS TESTING I hereby certify that the spill containers were tested in accordance with California Code of Regulations , Title 23 , Division 3, Chapter 16 , Section 2637. 1 and all the information contained herein is accurate. UST Service Technician Signature F If the facility has more components than this form accommodates, additional copies of this page may be attached. I CERS = California Environmental Reporting System, ID = Identification, UST = Underground Storage Tank, ICC = International Code Council