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rN <br />Nw <br />Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Formtr, <br />TYPE OF ACTION ❑ Installation <br />El Repair Li6 on I <br />1. FACILITY INFORMATION <br />CERS ID <br />10134451 <br />Facility Name <br />Unocal 76 <br />Facility Address <br />2701 (Nest March Lane <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Able Maintenance, Inc. <br />�;; <br />g Addressgional Parkway, Santa Rosa CA 95403 <br />Service Technician Performing Test <br />Eusebio Sousa <br />Contractor/Tank Tester License Number <br />Able Maintenance, Inc. / 312844 <br />ICC Number <br />5254516 <br />3. TRAINING AND CERTIFICATIONS <br />1 Manufacturer and Test Equipment Training Certifications <br />INCON TS -STS L4 - 1012573708 <br />4. TEST PROCEDURE INFORMATION _ <br />Test Procedures Used Components Tested <br />Hydrostatic I UDC's <br />Pressure <br />Secondary piping <br />❑ 36 Month <br />Test Date <br />031211202.3 <br />Cit =9521Sl <br />Code <br />Stockton <br />Phone <br />(707) 545-5522 <br />ICC Expiration Date <br />0612512023 <br />Expiration Date <br />0312012024 <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />/hereby certify that the secondary containment was tested in alccordance 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 />0312112023 4 <br />CERS = California Environmeal Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispense containment, <br />Page 1 <br />. <br />Ilk" <br />rN <br />Nw <br />Appendix VII <br />Underground Storage Tank <br />Secondary Containment Testing Report Formtr, <br />TYPE OF ACTION ❑ Installation <br />El Repair Li6 on I <br />1. FACILITY INFORMATION <br />CERS ID <br />10134451 <br />Facility Name <br />Unocal 76 <br />Facility Address <br />2701 (Nest March Lane <br />2. SERVICE TECHNICIAN INFORMATION <br />Company Performing the Test <br />Able Maintenance, Inc. <br />�;; <br />g Addressgional Parkway, Santa Rosa CA 95403 <br />Service Technician Performing Test <br />Eusebio Sousa <br />Contractor/Tank Tester License Number <br />Able Maintenance, Inc. / 312844 <br />ICC Number <br />5254516 <br />3. TRAINING AND CERTIFICATIONS <br />1 Manufacturer and Test Equipment Training Certifications <br />INCON TS -STS L4 - 1012573708 <br />4. TEST PROCEDURE INFORMATION _ <br />Test Procedures Used Components Tested <br />Hydrostatic I UDC's <br />Pressure <br />Secondary piping <br />❑ 36 Month <br />Test Date <br />031211202.3 <br />Cit =9521Sl <br />Code <br />Stockton <br />Phone <br />(707) 545-5522 <br />ICC Expiration Date <br />0612512023 <br />Expiration Date <br />0312012024 <br />5. CERTIFICATION BY SERVICE TECHNICIAN CONDUCTING TEST <br />/hereby certify that the secondary containment was tested in alccordance 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 />0312112023 4 <br />CERS = California Environmeal Reporting System, ICC = International Code Council, <br />ID = Identification, NA = Not Applicable, UDC = Under -Dispense containment, <br />Page 1 <br />