Laserfiche WebLink
Appendix VII <br /> Underground Storage Tank <br /> Secondary Containment Testing Report Form <br /> TYPE OF ACTION ❑ Installation ❑ Repair ❑ 6 Month W] 36 Month <br /> 1. FACILITY INFORMATION <br /> CERS ID Test Date <br /> 10181431 08/16/2022 <br /> Facility Name <br /> Valero <br /> Facility Address City ZIP Code <br /> 1700 E. Yosemite Ave. Manteca 95336 <br /> 2. SERVICE TECHNICIAN INFORMATION <br /> Company Performing the Test Phone <br /> Tank-Tight Systems, Inc. (916)378-4167 <br /> Mailing Address 1729 Crystal Ct., Olivehurst, CA 95961 <br /> Service Technician Performing Test <br /> BRIAN ROTH <br /> Contractor/Tank Tester License Number <br /> 1066914 A HAZ <br /> ICC Number 8834817 ICC Expiration Date <br /> —111/14/2023 <br /> 3. TRAINING AND CERTIFICATIONS <br /> Manufacturer and Test Equipment Training Certifications Expiration Date <br /> Installation and Replacement of Vaporless Manufacturing, Inc. Mechanical Line Leak Detector 10/23/2023 <br /> Veeder Tech ATG Installer#A29945 10/24/2023 <br /> 4. TEST PROCEDURE INFORMATION <br /> Test Procedures Used Components Tested <br /> Vacuum 87,91,Annulars <br /> Pressure 87,91 vapor line secondary <br /> Hydrostatic 87,91,turbin sumps Disp1-2,3-4,5-6,7-8 <br /> 5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br /> I hereby certify that the secondary containment was tested in accordance with California <br /> Code of Regulations, title 23, division 3, chapter 16, section 2637, that required supporting <br /> documentation is attached, and all information contained herein is accurate. I understand <br /> that test procedures shall be made available upon request by the governing authority. <br /> Service Technician Signature Date Total # of Pages <br /> /*:D 8-16-2022 5 <br /> CERS = California Environmental Reporting System, ICC = International Code Council, <br /> ID = Identification, NA = Not Applicable, UDC = Under-Dispenser Containment, <br /> Page 1 of 5 <br />